Provider Demographics
NPI:1982016630
Name:MIDDLETON, JOE BRIAN (APRN-FNP)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:BRIAN
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1774 SPILLMAN RD
Mailing Address - Street 2:
Mailing Address - City:CAVE CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42127-9128
Mailing Address - Country:US
Mailing Address - Phone:270-537-5451
Mailing Address - Fax:
Practice Address - Street 1:310 N L ROGERS WELLS BLVD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1300
Practice Address - Country:US
Practice Address - Phone:270-659-5555
Practice Address - Fax:270-659-5566
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008673363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100299500Medicaid
P01345178OtherRAILROAD MEDICARE
KY000000879197OtherANTHEM
KYK140460Medicare PIN