Provider Demographics
NPI:1972684215
Name:ISFORT, DONNA R (APRN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:R
Last Name:ISFORT
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 1:275 COURT ST
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336-1077
Mailing Address - Country:US
Mailing Address - Phone:606-723-2167
Mailing Address - Fax:606-723-2112
Practice Address - Street 1:275 COURT ST
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-1077
Practice Address - Country:US
Practice Address - Phone:606-723-2167
Practice Address - Fax:606-723-2112
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1055462163W00000X
KY3004648363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78015005Medicaid
KYK092441Medicare PIN
KYQ52976Medicare UPIN
KY78015005Medicaid