Provider Demographics
NPI:1184607871
Name:ISAAC, KATHLEEN (APRN CNM)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:ISAAC
Suffix:
Gender:F
Credentials:APRN CNM
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 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-864-1472
Mailing Address - Fax:270-864-1693
Practice Address - Street 1:141 N EAGLE CREEK DR STE 200
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2538
Practice Address - Country:US
Practice Address - Phone:859-323-9897
Practice Address - Fax:859-257-0629
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3000581363LX0001X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78003100Medicaid
KYK032410Medicare PIN
KY0613006Medicare PIN
KY000000041865OtherANTHEM PIN
KY0612806Medicare PIN
KYR17185Medicare UPIN
KY0728803Medicare PIN
KY0612906Medicare PIN