Provider Demographics
NPI:1356640668
Name:SNOW PENTICUFF, LAUREN DANIELLE (APRN)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:DANIELLE
Last Name:SNOW PENTICUFF
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 1:414 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-2012
Mailing Address - Country:US
Mailing Address - Phone:606-451-9210
Mailing Address - Fax:
Practice Address - Street 1:233 PARKERS MILL WAY
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-4152
Practice Address - Country:US
Practice Address - Phone:606-485-9323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006874363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100157170Medicaid
KY7100157170Medicaid
KYP400043735Medicare PIN
KYP400043741Medicare PIN
KYP400043733Medicare PIN
KY20901211Medicaid
KY7100157170Medicaid
KYP400043738Medicare PIN
KYP400043736Medicare PIN
KYP400043743Medicare PIN
KYP400043742Medicare PIN
KYP400043739Medicare PIN