Healthcare Provider Details

I. General information

NPI: 1972014538
Provider Name (Legal Business Name): MICHELLE RENE GOVER APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2017
Last Update Date: 10/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 OLD CORNWALLIS RD STE 200
DURHAM NC
27713-1869
US

IV. Provider business mailing address

209 ROSEWOOD DR
BARDSTOWN KY
40004-1127
US

V. Phone/Fax

Practice location:
  • Phone: 844-932-5700
  • Fax:
Mailing address:
  • Phone: 502-641-8944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1146175
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3011685
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5009991
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: