Basic Information
Provider Information
NPI: 1003155029
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARLEY
FirstName: KIM
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: RINGER
OtherFirstName: KIM
OtherMiddleName: ANN
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 23229
Address2:  
City: OWENSBORO
State: KY
PostalCode: 423043229
CountryCode: US
TelephoneNumber: 2706881330
FaxNumber: 2706881338
Practice Location
Address1: 1325 TRIPLETT ST # A
Address2:  
City: OWENSBORO
State: KY
PostalCode: 423033163
CountryCode: US
TelephoneNumber: 2706868500
FaxNumber: 2706865467
Other Information
ProviderEnumerationDate: 02/12/2013
LastUpdateDate: 06/24/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/24/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200X71004326AINN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
363LF0000X3010109KYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

ID Information
IDTypeStateIssuerDescription
710024056005KY MEDICAID


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