Provider Demographics
NPI:1023115656
Name:RAGER, MICHAEL W (APRN, DNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:RAGER
Suffix:
Gender:M
Credentials:APRN, DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1661
Mailing Address - Country:US
Mailing Address - Phone:270-825-7200
Mailing Address - Fax:
Practice Address - Street 1:200 CLINIC DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1661
Practice Address - Country:US
Practice Address - Phone:270-825-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4701P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4701POtherLICENSE
000000383216OtherBCBS PROVIDER NUMBER
KY78017332Medicaid
000000383216OtherBCBS PROVIDER NUMBER
KYP400041336Medicare PIN
0683234Medicare PIN
KY78017332Medicaid
0745821Medicare PIN
Q61925Medicare UPIN
0903659Medicare PIN
KY4701POtherLICENSE
KYK018300Medicare PIN
KYP400032928Medicare PIN
0601431Medicare PIN
0771915Medicare PIN