Provider Demographics
NPI:1306185053
Name:CUMMINS, ADAM WAYNE (ARNP)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:WAYNE
Last Name:CUMMINS
Suffix:
Gender:M
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 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:9880 ANGIES WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2865
Practice Address - Country:US
Practice Address - Phone:502-584-7525
Practice Address - Fax:502-584-6851
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007770363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50074035OtherPASSPORT-NLSC
KY000000882175OtherANTHEM-NLSC
KY163574OtherSIHO-NLSC
KY7100238180Medicaid
KY000000882175OtherANTHEM-NLSC