Provider Demographics
NPI:1609462134
Name:GUDGEON, NANCY KAY (RN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:KAY
Last Name:GUDGEON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5787 FORSYTHIA CT
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41015-4217
Mailing Address - Country:US
Mailing Address - Phone:859-912-4537
Mailing Address - Fax:
Practice Address - Street 1:5787 FORSYTHIA CT
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41015-4217
Practice Address - Country:US
Practice Address - Phone:859-912-4537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1060774163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty