Healthcare Provider Details

I. General information

NPI: 1588679138
Provider Name (Legal Business Name): PATRICIA DERIFIELD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 PROFESSIONAL PARK DR
LOUISA KY
41230-9644
US

IV. Provider business mailing address

PO BOX 790
ASHLAND KY
41105-0790
US

V. Phone/Fax

Practice location:
  • Phone: 606-638-4332
  • Fax: 606-638-4394
Mailing address:
  • Phone: 606-329-8588
  • Fax: 606-329-8195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number1027359
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: