Provider Demographics
NPI:1760006217
Name:FREEMAN, MARTHA SUZANNE (APRN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:SUZANNE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SUZI
Other - Middle Name:
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:431 REGES RD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336-8442
Mailing Address - Country:US
Mailing Address - Phone:859-361-9678
Mailing Address - Fax:
Practice Address - Street 1:431 REGES RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-8442
Practice Address - Country:US
Practice Address - Phone:859-361-9678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1067902101YM0800X
KY3014803363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100723690Medicaid