=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811613995
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GABRIELLE KIEDREN LOUISE HOLDEN PMHNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2022
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2430 MONTICELLO RD
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42501-3019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-425-4567
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1646 PRATHER DR
-----------------------------------------------------
City | NANCY
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42544-8724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-241-8323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 3018477
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------