Healthcare Provider Details

I. General information

NPI: 1639431810
Provider Name (Legal Business Name): DEBRA L TAFT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 BOGLE OFFICE PARK DR
SOMERSET KY
42503-2810
US

IV. Provider business mailing address

520 TECHWOOD DR N SUITE 100
DANVILLE KY
40422-8500
US

V. Phone/Fax

Practice location:
  • Phone: 606-677-1451
  • Fax: 606-678-0814
Mailing address:
  • Phone: 859-936-9844
  • Fax: 859-236-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3007561
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1075008
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: