Healthcare Provider Details

I. General information

NPI: 1194347617
Provider Name (Legal Business Name): BREANNA FUHRMAN APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 ROGERSVILLE RD
RADCLIFF KY
40160-9344
US

IV. Provider business mailing address

1360 ROGERSVILLE RD
RADCLIFF KY
40160-9344
US

V. Phone/Fax

Practice location:
  • Phone: 270-351-0086
  • Fax:
Mailing address:
  • Phone: 270-351-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3016233
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1154856
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: