Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 3009684 | KY |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 3009684 | KY |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 3009684 | KY |
NPI | 1053782417 |
---|---|
Provider Name | Martina Renate Myers |
First Address | Ashland, KY 41105-2379 |
Second Address | Ashland, KY 41101-2843 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2015 |
Last Update Date | 22/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100463860 | (05) | KY |