Healthcare Provider Details

I. General information

NPI: 1063954121
Provider Name (Legal Business Name): JANUARY HAMBY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE
LEXINGTON KY
40536-7919
US

IV. Provider business mailing address

615 E BRANNON RD STE 100
NICHOLASVILLE KY
40356-7919
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6700
  • Fax: 859-257-1331
Mailing address:
  • Phone: 502-594-1367
  • Fax: 859-278-6867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number3011357
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1091604
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3011357
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: