Provider Demographics
NPI:1043292709
Name:BAGBY, GLENDA DARLENE (ARNP-BC, MSN, CEN)
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:DARLENE
Last Name:BAGBY
Suffix:
Gender:F
Credentials:ARNP-BC, MSN, CEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:42743-1429
Mailing Address - Country:US
Mailing Address - Phone:270-299-2286
Mailing Address - Fax:270-299-2157
Practice Address - Street 1:310 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-1429
Practice Address - Country:US
Practice Address - Phone:270-299-2286
Practice Address - Fax:270-299-2157
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4331P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78012515Medicaid
KY78012515Medicaid
KY78012515Medicaid