Provider Demographics
NPI:1013105139
Name:DENNIS, NANCY (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 HIDDEN FOREST RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-8300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:608 HAPPY VALLEY RD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1561
Practice Address - Country:US
Practice Address - Phone:270-901-5000
Practice Address - Fax:270-651-9248
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY27004019Medicaid