Provider Demographics
NPI:1205948999
Name:LITTLE, GLENNIS MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:GLENNIS
Middle Name:MARIE
Last Name:LITTLE
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 1:1893 REDFOX RD.
Mailing Address - Street 2:
Mailing Address - City:REDFOX
Mailing Address - State:KY
Mailing Address - Zip Code:41847-0098
Mailing Address - Country:US
Mailing Address - Phone:606-642-3240
Mailing Address - Fax:606-642-3750
Practice Address - Street 1:1893 REDFOX RD.
Practice Address - Street 2:
Practice Address - City:REDFOX
Practice Address - State:KY
Practice Address - Zip Code:41847-0098
Practice Address - Country:US
Practice Address - Phone:606-642-3240
Practice Address - Fax:606-642-3750
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78001385Medicaid
S47662Medicare UPIN
KY78001385Medicaid