Basic Information
| Provider Information | |||||||||
| NPI: | 1043640659 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHUMLEY | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | COLE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APRN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BRANSON | ||||||||
| OtherFirstName: | CHRISTINA | ||||||||
| OtherMiddleName: | COLE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | APRN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1079 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424191079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708270353 | ||||||||
| FaxNumber: | 2708274966 | ||||||||
| Practice Location | |||||||||
| Address1: | 121 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424501268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706672023 | ||||||||
| FaxNumber: | 2706677518 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2013 | ||||||||
| LastUpdateDate: | 11/21/2013 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 3008400 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.