Healthcare Provider Details

I. General information

NPI: 1386887511
Provider Name (Legal Business Name): BECKY B SWANN RNBSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 HARDIN LN
SOMERSET KY
42503-3800
US

IV. Provider business mailing address

104 HARDIN LN
SOMERSET KY
42503-3800
US

V. Phone/Fax

Practice location:
  • Phone: 606-676-0786
  • Fax: 606-676-9737
Mailing address:
  • Phone: 606-676-0786
  • Fax: 606-676-9737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1040664
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: