Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 3015437 | KY |
N | 363L00000X | Nurse Practitioner | APRN.CNP.026339 | OH |
Y | 363LN0000X | Nurse Practitioner - Neonatal | 3015437 | KY |
NPI | 1194363887 |
---|---|
Provider Name | Shannon Bracey |
First Address | Cincinnati, OH 45229-3026 |
Second Address | Lexington, KY 40536 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2019 |
Last Update Date | 04/03/2021 |