Provider Demographics
NPI:1508001363
Name:CORDOVA, PAULA B (APRN)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:B
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:S
Other - Last Name:BARNETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:4321 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:HORSE CAVE
Mailing Address - State:KY
Mailing Address - Zip Code:42749-1482
Mailing Address - Country:US
Mailing Address - Phone:270-834-0682
Mailing Address - Fax:
Practice Address - Street 1:4321 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HORSE CAVE
Practice Address - State:KY
Practice Address - Zip Code:42749-1482
Practice Address - Country:US
Practice Address - Phone:270-834-0682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005687363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY710068320Medicaid
11916486OtherCAQH