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General NPI Number Information
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NPI Number | 1699183608
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Entity Type | Individual
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Provider Name | CHRISTEEN IVY BROADDUS APRN
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Gender | Female
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | UK DIVISION OF HOSPITAL MEDICINE 800 ROSE ST, MN604
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City | LEXINGTON
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State | KY
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Zip | 40536-0298
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Country | US
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Telephone | 859-323-6047
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Fax | 859-257-3873
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Provider Business Mailing Address
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Address Line | UK DIVISION OF HOSPITAL MEDICINE 800 ROSE ST, MN604
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City | LEXINGTON
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State | KY
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Zip | 40536-0298
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Country | US
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Telephone | 859-323-6047
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Fax | 859-257-3873
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3008794
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 3008794
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License Number State | KY
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