Provider Demographics
NPI:1346673647
Name:RUSSELL, KATOSHA NICOLE (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KATOSHA
Middle Name:NICOLE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:KATOSHA
Other - Middle Name:NICOLE
Other - Last Name:THORNSBERRY-RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APRN, FNP-BC
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:270-789-1112
Mailing Address - Fax:270-789-3157
Practice Address - Street 1:73 KINGSWOOD DR
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-9604
Practice Address - Country:US
Practice Address - Phone:270-789-1112
Practice Address - Fax:270-789-3157
Is Sole Proprietor?:No
Enumeration Date:2013-08-10
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008196363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily