Provider Demographics
NPI:1942291422
Name:WARD, GENIENE EILEEN (APRN)
Entity Type:Individual
Prefix:
First Name:GENIENE
Middle Name:EILEEN
Last Name:WARD
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 1:2833 PADDOCK LN
Mailing Address - Street 2:
Mailing Address - City:VILLA HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3656
Mailing Address - Country:US
Mailing Address - Phone:859-331-4105
Mailing Address - Fax:
Practice Address - Street 1:2002 MADISON AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41014-1210
Practice Address - Country:US
Practice Address - Phone:859-431-3345
Practice Address - Fax:859-655-6374
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3001119363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100129260Medicaid