Healthcare Provider Details

I. General information

NPI: 1588637961
Provider Name (Legal Business Name): GINGER RENEE COMBS ARNP RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GINGER RENEE FITZGERALD APRN

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 THANNOLI DR
SOMERSET KY
42503
US

IV. Provider business mailing address

55 THANNOLI DR
SOMERSET KY
42503
US

V. Phone/Fax

Practice location:
  • Phone: 606-677-0854
  • Fax: 606-677-9311
Mailing address:
  • Phone: 606-677-0854
  • Fax: 606-677-9311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4692P
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number1063460
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: