Provider Demographics
NPI:1659550069
Name:WALDRON, GINGER RENEE (MSN)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:RENEE
Last Name:WALDRON
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:RENEE
Other - Last Name:HOLLOMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1653
Mailing Address - Country:US
Mailing Address - Phone:270-825-5100
Mailing Address - Fax:
Practice Address - Street 1:900 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1653
Practice Address - Country:US
Practice Address - Phone:270-825-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5335A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100024780Medicaid
KY5335AOtherLICENSE
KYP00473527Medicare PIN
KY5335AOtherLICENSE