Healthcare Provider Details

I. General information

NPI: 1144270505
Provider Name (Legal Business Name): BEVERLY ANN HOLBERT N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W WALNUT ST
LEBANON KY
40033-1377
US

IV. Provider business mailing address

390 NEWTON VALLEY LN
NEW HAVEN KY
40051-6155
US

V. Phone/Fax

Practice location:
  • Phone: 270-699-9500
  • Fax: 270-699-9550
Mailing address:
  • Phone: 502-549-3309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3313P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: