Provider Demographics
NPI:1144743782
Name:PACKWOOD, GERI LYNN (DNP,MS,APRN,AGACNP)
Entity Type:Individual
Prefix:
First Name:GERI
Middle Name:LYNN
Last Name:PACKWOOD
Suffix:
Gender:F
Credentials:DNP,MS,APRN,AGACNP
Other - Prefix:
Other - First Name:GERI
Other - Middle Name:LYNN
Other - Last Name:SIPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP,MS,APRN,AGACNP
Mailing Address - Street 1:800 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-7001
Mailing Address - Country:US
Mailing Address - Phone:859-323-6047
Mailing Address - Fax:859-257-3873
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-7001
Practice Address - Country:US
Practice Address - Phone:859-323-6047
Practice Address - Fax:859-257-3873
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011492363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner