Provider Demographics
NPI:1225221013
Name:O'BRYAN, NANCY ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:O'BRYAN
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 1919
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-1919
Mailing Address - Country:US
Mailing Address - Phone:270-926-2273
Mailing Address - Fax:270-926-5200
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:BUILDING A
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-926-2273
Practice Address - Fax:270-926-5200
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5270P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61-0890594OtherTAX ID
KY1281027Medicare PIN