Provider Demographics
NPI:1467420364
Name:DABNEY, GINA MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:DABNEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:SQUEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1010 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:MC KEE
Mailing Address - State:KY
Mailing Address - Zip Code:40447-7089
Mailing Address - Country:US
Mailing Address - Phone:606-287-7104
Mailing Address - Fax:606-287-4409
Practice Address - Street 1:1010 MAIN ST S
Practice Address - Street 2:
Practice Address - City:MC KEE
Practice Address - State:KY
Practice Address - Zip Code:40447-7089
Practice Address - Country:US
Practice Address - Phone:606-287-7104
Practice Address - Fax:606-287-4409
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY300351363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
1228208OtherCHA HHC
000000359189OtherBCBS HHC
KY78013786Medicaid
7274663OtherAETNA
7274663OtherAETNA
1228208OtherCHA HHC