Provider Demographics
NPI:1356640668
Name:SNOW PENTICUFF, LAUREN DANIELLE (APRN)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:DANIELLE
Last Name:SNOW PENTICUFF
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:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:NANCY
Mailing Address - State:KY
Mailing Address - Zip Code:42544-0628
Mailing Address - Country:US
Mailing Address - Phone:606-288-0013
Mailing Address - Fax:606-288-9600
Practice Address - Street 1:9245 W HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:NANCY
Practice Address - State:KY
Practice Address - Zip Code:42544-8767
Practice Address - Country:US
Practice Address - Phone:606-288-0013
Practice Address - Fax:606-288-9600
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006874363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100157170Medicaid
KY7100157170Medicaid
KYP400043735Medicare PIN
KYP400043741Medicare PIN
KYP400043733Medicare PIN
KY20901211Medicaid
KY7100157170Medicaid
KYP400043738Medicare PIN
KYP400043736Medicare PIN
KYP400043743Medicare PIN
KYP400043742Medicare PIN
KYP400043739Medicare PIN