Healthcare Provider Details

I. General information

NPI: 1982124491
Provider Name (Legal Business Name): GINA C OWENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S 12TH ST
MURRAY KY
42071
US

IV. Provider business mailing address

1000 SOUTH 12TH STREET FAMILY PRACTICE
MURRAY KY
42071
US

V. Phone/Fax

Practice location:
  • Phone: 270-759-9200
  • Fax: 270-759-9966
Mailing address:
  • Phone: 270-759-9200
  • Fax: 270-759-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3011373
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201800838NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: