Provider Demographics
NPI:1033324439
Name:CAVANAH, SUE ANN (APRN)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ANN
Last Name:CAVANAH
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 1:970 CINDY DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-9303
Mailing Address - Country:US
Mailing Address - Phone:410-382-7647
Mailing Address - Fax:410-382-7647
Practice Address - Street 1:970 CINDY DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-9303
Practice Address - Country:US
Practice Address - Phone:410-382-7647
Practice Address - Fax:410-382-7647
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004241363LF0000X
TXAP129880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100207240Medicaid
KYK114190Medicare PIN