Provider Demographics
NPI:1639431810
Name:TAFT, DEBRA L (APRN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:TAFT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 TECHWOOD DR N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-8500
Mailing Address - Country:US
Mailing Address - Phone:859-936-9844
Mailing Address - Fax:859-236-0320
Practice Address - Street 1:95 BOGLE OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2810
Practice Address - Country:US
Practice Address - Phone:606-677-1451
Practice Address - Fax:606-678-0814
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1075008163W00000X
KY3007561363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
C61028OtherCUMBERLAND HEALTHCARE, INC.
KY7100217700Medicaid
KY000000778714OtherANTHEM BLUE CROSS BLUE SHIELD
KYP01161874OtherRAILROAD MEDICARE
KY7100217700Medicaid