Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 3005720 | KY |
Y | 363LA2200X | Nurse Practitioner - Adult Health | 5720P | KY |
N | 363LG0600X | Nurse Practitioner - Gerontology | 5720P | KY |
NPI | 1033358072 |
---|---|
Provider Name | Mary T Skinner |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40208-1450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2009 |
Last Update Date | 21/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00706702 | RAILROAD MEDICARE (01) | KY |