Healthcare Provider Details

I. General information

NPI: 1568538981
Provider Name (Legal Business Name): KIMBERLY DENISE EAST APRN-WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N EAGLE CREEK DR SUITE 400
LEXINGTON KY
40509-2121
US

IV. Provider business mailing address

160 N EAGLE CREEK DR STE 400
LEXINGTON KY
40509-2121
US

V. Phone/Fax

Practice location:
  • Phone: 859-258-5220
  • Fax: 859-258-5405
Mailing address:
  • Phone: 859-258-5220
  • Fax: 859-258-5405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1358P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: