=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295967792
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALISON CONNELL ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2009
-----------------------------------------------------
Last Update Date | 08/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 62 MERCY CT
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40336-1331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-723-5142
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 155 GOODRICH AVE
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40503-1911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-533-3866
-----------------------------------------------------
Fax | 859-257-8478
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1052949
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------