Provider Demographics
NPI:1023262540
Name:BACK, NATALIE LISA (APRN)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:LISA
Last Name:BACK
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 1:269 OAKDALE DR
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40313-9762
Mailing Address - Country:US
Mailing Address - Phone:606-776-2865
Mailing Address - Fax:
Practice Address - Street 1:306 W MAIN ST STE 512
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-1840
Practice Address - Country:US
Practice Address - Phone:574-546-1900
Practice Address - Fax:574-546-1999
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004334363LP0808X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100108660Medicaid