Provider Demographics
NPI:1235672726
Name:BAGBY, KIM (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:BAGBY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 CHIMNEY ROCK DR
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-6247
Mailing Address - Country:US
Mailing Address - Phone:502-550-4575
Mailing Address - Fax:
Practice Address - Street 1:235 CHIMNEY ROCK DR
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-6247
Practice Address - Country:US
Practice Address - Phone:502-550-4575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010883363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily