Provider Demographics
NPI:1023550761
Name:ALBRITTON, DESIREE (APRN)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:ALBRITTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5439 STEVIN DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-9705
Mailing Address - Country:US
Mailing Address - Phone:270-559-3110
Mailing Address - Fax:
Practice Address - Street 1:5439 STEVIN DR UNIT B
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-9705
Practice Address - Country:US
Practice Address - Phone:270-559-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-11
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010751363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3010750OtherKY APRN LIC