Provider Demographics
NPI:1376094185
Name:PIPER, SUSAN EVANGLINE (APRN-NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:EVANGLINE
Last Name:PIPER
Suffix:
Gender:F
Credentials:APRN-NP
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 297
Mailing Address - Street 2:
Mailing Address - City:LEWISPORT
Mailing Address - State:KY
Mailing Address - Zip Code:42351-0297
Mailing Address - Country:US
Mailing Address - Phone:270-231-3687
Mailing Address - Fax:270-295-6452
Practice Address - Street 1:1210 4TH ST
Practice Address - Street 2:
Practice Address - City:LEWISPORT
Practice Address - State:KY
Practice Address - Zip Code:42351-2526
Practice Address - Country:US
Practice Address - Phone:270-295-6450
Practice Address - Fax:270-295-6452
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010798363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health