Provider Demographics
NPI:1093428245
Name:GHOLSON, SUE ANN (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ANN
Last Name:GHOLSON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10925 WOMBLE RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-9210
Mailing Address - Country:US
Mailing Address - Phone:270-556-4057
Mailing Address - Fax:
Practice Address - Street 1:10925 WOMBLE RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-9210
Practice Address - Country:US
Practice Address - Phone:270-556-4057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018715363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily