Provider Demographics
NPI:1134231285
Name:MARGISON, GLORIA (ARNP)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:
Last Name:MARGISON
Suffix:
Gender:F
Credentials:ARNP
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 495
Mailing Address - Street 2:
Mailing Address - City:EAST BERNSTADT
Mailing Address - State:KY
Mailing Address - Zip Code:40729-0495
Mailing Address - Country:US
Mailing Address - Phone:606-843-6195
Mailing Address - Fax:606-287-8031
Practice Address - Street 1:2659 NORTH LAUREL RD
Practice Address - Street 2:
Practice Address - City:EAST BERNSTADT
Practice Address - State:KY
Practice Address - Zip Code:40729-4072
Practice Address - Country:US
Practice Address - Phone:606-843-6195
Practice Address - Fax:606-287-8031
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2652P363L00000X
KY3002652363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7800500600Medicaid
KYOTH000Medicare UPIN
KY7800500600Medicaid
KY0374015Medicare PIN
KY0230816Medicare PIN
KY0736410Medicare PIN
KY0873412Medicare PIN