Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 71004326A | IN |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3010109 | KY |
NPI | 1003155029 |
---|---|
Provider Name | Kim Ann Harley |
First Address | Owensboro, KY 42304-3229 |
Second Address | Owensboro, KY 42303-3163 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2013 |
Last Update Date | 24/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100240560 | (05) | KY |
K199550 | (02) | KY |