Healthcare Provider Details

I. General information

NPI: 1427508738
Provider Name (Legal Business Name): VALERIE BREEDING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VALERIE LEIGH SIPPLE

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 RICHMOND PLZ
RICHMOND KY
40475-2564
US

IV. Provider business mailing address

3403 BERKSHIRE CIR
JOHNSON CITY TN
37604-8922
US

V. Phone/Fax

Practice location:
  • Phone: 859-623-5155
  • Fax:
Mailing address:
  • Phone: 423-440-9287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3010839
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: