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General NPI Number Information
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NPI Number | 1881974418
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Entity Type | Organization
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Legal Business Name | DONAVAN, PSC
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Dates
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Enumeration Date | 08/26/2011
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 726 S US HIGHWAY 25E
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City | BARBOURVILLE
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State | KY
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Zip | 40906-7316
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Country | US
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Telephone | 606-627-0525
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Fax | 606-546-4579
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Provider Business Mailing Address
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Address Line | PO BOX 310
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City | BARBOURVILLE
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State | KY
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Zip | 40906-0310
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Country | US
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Telephone | 606-627-0525
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Fax | 606-546-4579
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Authorized Official
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Title or Position | OWNER/APRN
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Name | MRS. MICHELLE LOUISE BROUGHTON
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Credential | APRN
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Telephone | 606-627-5565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3006067P
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License Number State | KY
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