Provider Demographics
NPI:1265260061
Name:MAHIN, CONSTANCE LOUISE (APRN FNP-C)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:LOUISE
Last Name:MAHIN
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2294 LOWER BRUSH CREEK RD LOWR BRUSH
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:42539-6339
Mailing Address - Country:US
Mailing Address - Phone:317-427-8240
Mailing Address - Fax:
Practice Address - Street 1:757 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1838
Practice Address - Country:US
Practice Address - Phone:270-972-4186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4022839363L00000X, 363LP0222X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care