Provider Demographics
NPI:1629030465
Name:KLOSS, MARTHA JUNE (ARNP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JUNE
Last Name:KLOSS
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 1:225 MEDICAL CENTER DR
Mailing Address - Street 2:STE. 304
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7914
Mailing Address - Country:US
Mailing Address - Phone:270-441-4301
Mailing Address - Fax:270-441-4739
Practice Address - Street 1:225 MEDICAL CENTER DR
Practice Address - Street 2:STE. 304
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7914
Practice Address - Country:US
Practice Address - Phone:270-441-4301
Practice Address - Fax:270-441-4739
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYARNP 3987P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78010808Medicaid
P94582Medicare UPIN
KY78010808Medicaid