Provider Demographics
NPI:1144209214
Name:GENTRY, VICKI (ARNP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:GENTRY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:GREEN RIVER DISTRICT HEALTH DEPARTMENT
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-0309
Mailing Address - Country:US
Mailing Address - Phone:270-686-7747
Mailing Address - Fax:270-926-9862
Practice Address - Street 1:472 KLUTEY PARK PLAZA DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-3348
Practice Address - Country:US
Practice Address - Phone:270-826-3951
Practice Address - Fax:270-827-5527
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2606P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100007260Medicaid
P40125Medicare UPIN
0282810Medicare UPIN
0049212Medicare PIN
0282405Medicare PIN
0282710Medicare PIN