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NPI Code Detail

MEDICARE: CONSTANCE R PROSTKO APRN

MEDICARE: CONSTANCE R PROSTKO 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
1363L00000XNurse Practitioner3001854KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508836487
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONSTANCE R PROSTKO APRN
Provider Business Mailing Address
First Line : 1704 W STOCKTON ST
Second Line :
City : EDMONTON
State : KY
Zip : 42129-8137
Country : US
Telephone Number : 270-432-4800
Fax Number : 270-432-4804
Provider Business Practice Location Address
First Line : 1704 W STOCKTON ST
Second Line :
City : EDMONTON
State : KY
Zip : 42129-8137
Country : US
Telephone Number : 270-432-4800
Fax Number : 270-432-4804
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2006
Last Update Date : 03/02/2023

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Directions to “ CONSTANCE R PROSTKO APRN” Practice Location

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