=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215642459
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LILLIAN KENDALL HAMM APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2023
-----------------------------------------------------
Last Update Date | 10/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 197 WILL WALKER RD
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42728-7436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-384-9981
-----------------------------------------------------
Fax | 270-384-9989
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1080
-----------------------------------------------------
City | BURKESVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42717-1080
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-864-1472
-----------------------------------------------------
Fax | 270-864-1693
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 266159
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 4026971
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 5018722
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------