Provider Demographics
NPI:1134123995
Name:MYERS, DENNIS C (NP-C, AAHIVS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:C
Last Name:MYERS
Suffix:
Gender:M
Credentials:NP-C, AAHIVS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 E COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-9133
Mailing Address - Country:US
Mailing Address - Phone:812-475-1948
Mailing Address - Fax:812-401-1267
Practice Address - Street 1:6140 E COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-9133
Practice Address - Country:US
Practice Address - Phone:812-475-1948
Practice Address - Fax:812-401-1267
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000351A363L00000X
KY3545P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000651266OtherBLUE CROSS BLUE SHIELD
KY50013210OtherPASSPORT HEALTH PLAN
IN200187430Medicaid
KY78006970Medicaid
S91055Medicare UPIN
IN234140OMedicare PIN