Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 96376 | KY |
NPI | 1013068337 |
---|---|
Provider Name | Kristie L Thelen Mcmanus |
First Address | Florence, KY 41042-3901 |
Second Address | Florence, KY 41042-3901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 11/04/2017 |