Provider Demographics
NPI:1578508420
Name:PRICE-KAGAN, JEAN AUGUSTA (ARNP)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:AUGUSTA
Last Name:PRICE-KAGAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-1252
Mailing Address - Country:US
Mailing Address - Phone:859-885-4149
Mailing Address - Fax:859-885-1863
Practice Address - Street 1:210 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-1252
Practice Address - Country:US
Practice Address - Phone:859-885-4149
Practice Address - Fax:859-885-1863
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2014-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001072265163W00000X
VA0024072265363LF0000X
KY5283P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY09122Medicare PIN
S66263Medicare UPIN