MEDICARE: KATHLEEN M. EBBITT APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	3010575	KY
2	363LF0000X	Family Nurse Practitioner	3010575	KY

General Provider Information

NPI Number	:	1043761505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN M. EBBITT APRN

Provider Business Mailing Address
First Line	:	1221 S BROADWAY
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-2701
Country	:	US
Telephone Number	:	859-258-4450
Fax Number	:	859-258-4039

Provider Business Practice Location Address
First Line	:	740 S LIMESTONE ST
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-2701
Country	:	US
Telephone Number	:	859-218-1632
Fax Number	:	859-257-7799

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2016
Last Update Date	:	03/06/2018

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