Provider Demographics
NPI:1477010585
Name:KNUDSON, DEB (APRN)
Entity Type:Individual
Prefix:
First Name:DEB
Middle Name:
Last Name:KNUDSON
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 1:5914 DAKOTA DR
Mailing Address - Street 2:
Mailing Address - City:CATLETTSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41129-7801
Mailing Address - Country:US
Mailing Address - Phone:701-403-4000
Mailing Address - Fax:
Practice Address - Street 1:5914 DAKOTA DR
Practice Address - Street 2:
Practice Address - City:CATLETTSBURG
Practice Address - State:KY
Practice Address - Zip Code:41129-7801
Practice Address - Country:US
Practice Address - Phone:701-403-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1148188163W00000X
KY3017550363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3017550OtherAPRN
KY1148188OtherBSN RN
2022002856OtherAMERICAN NURSES CREDENTIALING CENTER ( ANCC)