Provider Demographics
NPI:1922196963
Name:HOVERMALE, RACHAEL (ARNP)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:HOVERMALE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:MC KEE
Mailing Address - State:KY
Mailing Address - Zip Code:40447-7089
Mailing Address - Country:US
Mailing Address - Phone:606-287-7104
Mailing Address - Fax:606-287-4409
Practice Address - Street 1:521 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3100
Practice Address - Country:US
Practice Address - Phone:859-622-1761
Practice Address - Fax:859-986-6752
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1080705363LP0808X
KY3003013364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100158910Medicaid
KYP36263Medicare UPIN
KY30615058Medicaid
KY8558Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
KY0331716Medicare ID - Type UnspecifiedMEDICARE