Provider Demographics
NPI:1649512351
Name:ARNETT, LOLA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:LOLA
Middle Name:MARIE
Last Name:ARNETT
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 406
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-0406
Mailing Address - Country:US
Mailing Address - Phone:606-349-6500
Mailing Address - Fax:606-349-6611
Practice Address - Street 1:100 BRIANNA BOULEVARD
Practice Address - Street 2:SUITE 100
Practice Address - City:SALYERSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41465-9811
Practice Address - Country:US
Practice Address - Phone:606-349-6500
Practice Address - Fax:606-349-6611
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007841363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100240530Medicaid
KYK085290Medicare PIN