Provider Demographics
NPI:1437846185
Name:BJURQUIST, TAWNY (APRN)
Entity Type:Individual
Prefix:
First Name:TAWNY
Middle Name:
Last Name:BJURQUIST
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 1:1206 EDINBURGH LN
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-9069
Mailing Address - Country:US
Mailing Address - Phone:859-912-5377
Mailing Address - Fax:
Practice Address - Street 1:530 W 9TH ST STE 201
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-1317
Practice Address - Country:US
Practice Address - Phone:859-444-8203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017849363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner