Provider Demographics
NPI:1689701898
Name:ALBERTSON, DANIEL C (ARNP)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:C
Last Name:ALBERTSON
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 W 5TH ST
Mailing Address - Street 2:#3
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1610
Mailing Address - Country:US
Mailing Address - Phone:606-862-9900
Mailing Address - Fax:606-862-8901
Practice Address - Street 1:1105 W 5TH ST
Practice Address - Street 2:#3
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1610
Practice Address - Country:US
Practice Address - Phone:606-862-9900
Practice Address - Fax:606-862-8901
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3216P363L00000X
KY3003216363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78004249Medicaid
KYP18712Medicare UPIN
KY78004249Medicaid
KY4586160001Medicare NSC