Healthcare Provider Details

I. General information

NPI: 1578508420
Provider Name (Legal Business Name): JEAN AUGUSTA PRICE-KAGAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 05/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E WALNUT ST
NICHOLASVILLE KY
40356-1252
US

IV. Provider business mailing address

210 E WALNUT ST
NICHOLASVILLE KY
40356-1252
US

V. Phone/Fax

Practice location:
  • Phone: 859-885-4149
  • Fax: 859-885-1863
Mailing address:
  • Phone: 859-885-4149
  • Fax: 859-885-1863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001072265
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024072265
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5283P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: