Provider Demographics
NPI:1982855433
Name:RANKIN, AUDRA NOBLE (DNP, APRN, CPNP)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:NOBLE
Last Name:RANKIN
Suffix:
Gender:F
Credentials:DNP, APRN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-3440
Mailing Address - Fax:502-588-3441
Practice Address - Street 1:555 S FLOYD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3822
Practice Address - Country:US
Practice Address - Phone:502-588-3440
Practice Address - Fax:502-588-3441
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5765363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100246430Medicaid
KYK061980Medicare PIN