Provider Demographics
NPI:1841211356
Name:DOEDEN, BRIANAH L (APRN)
Entity Type:Individual
Prefix:MRS
First Name:BRIANAH
Middle Name:L
Last Name:DOEDEN
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 1:2400 W G TALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ALVATON
Mailing Address - State:KY
Mailing Address - Zip Code:42122
Mailing Address - Country:US
Mailing Address - Phone:270-991-8674
Mailing Address - Fax:855-256-8774
Practice Address - Street 1:104 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:KY
Practice Address - Zip Code:42206-5106
Practice Address - Country:US
Practice Address - Phone:270-542-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4332P363LF0000X
KY3004332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78013893Medicaid
Q30136Medicare UPIN