Provider Demographics
NPI:1629055082
Name:HAMILTON, GINA MICHELLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MICHELLE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MICKI
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:333 BOGLE ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2873
Mailing Address - Country:US
Mailing Address - Phone:606-678-0705
Mailing Address - Fax:606-678-2807
Practice Address - Street 1:333 BOGLE ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2873
Practice Address - Country:US
Practice Address - Phone:606-678-0705
Practice Address - Fax:606-678-2807
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3001453363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20104014Medicaid
KY20109013Medicaid
KY20074019Medicaid
KY20023016Medicaid
KY20027017Medicaid
KY20100012Medicaid
KY20901211Medicaid
KY20116018Medicaid
S44114Medicare UPIN
KY20109013Medicaid
KY20023016Medicaid
KY300005Medicare PIN
KY300705Medicare PIN
KY300505Medicare PIN
KY300105Medicare PIN
KY300805Medicare PIN
KY300605Medicare PIN
KY20116018Medicaid
KY299905Medicare PIN