Healthcare Provider Details

I. General information

NPI: 1679941165
Provider Name (Legal Business Name): KATHERINE KUBAREK APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 OLD ROSEBUD RD 110
LEXINGTON KY
40509-8623
US

IV. Provider business mailing address

2700 OLD ROSEBUD RD 110
LEXINGTON KY
40509-8623
US

V. Phone/Fax

Practice location:
  • Phone: 859-264-1141
  • Fax: 859-264-1963
Mailing address:
  • Phone: 859-264-1141
  • Fax: 859-264-1963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3009724
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: