Provider Demographics
NPI:1518624659
Name:DAVID, CECILIA FOTABI (APRN)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:FOTABI
Last Name:DAVID
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 1:2093 SHAKER RUN RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8470
Mailing Address - Country:US
Mailing Address - Phone:859-583-3002
Mailing Address - Fax:
Practice Address - Street 1:1916 JUSTICE DR STE 120
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2609
Practice Address - Country:US
Practice Address - Phone:859-756-6837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11210414363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily