Provider Demographics
NPI:1588803142
Name:UNDERWOOD, BYRON D (RNFA)
Entity Type:Individual
Prefix:MR
First Name:BYRON
Middle Name:D
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1033
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40423-1033
Mailing Address - Country:US
Mailing Address - Phone:859-329-9105
Mailing Address - Fax:
Practice Address - Street 1:455 BOONE TRAIL RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1549
Practice Address - Country:US
Practice Address - Phone:859-329-9105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1039549163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant