Provider Demographics
NPI:1376265033
Name:GIRTON, BEVERLY A (LPN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:GIRTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 POPLAR LEVEL RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-1128
Mailing Address - Country:US
Mailing Address - Phone:502-434-5566
Mailing Address - Fax:502-434-5567
Practice Address - Street 1:4922 POPLAR LEVEL RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-1128
Practice Address - Country:US
Practice Address - Phone:502-434-5566
Practice Address - Fax:502-434-5567
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2034420164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2034420Medicaid