Provider Demographics
NPI:1649914748
Name:HEARNE, PHYLLIS ANN (RN)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:ANN
Last Name:HEARNE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ZORN AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1433
Mailing Address - Country:US
Mailing Address - Phone:618-364-6349
Mailing Address - Fax:
Practice Address - Street 1:2927 STATE ROUTE 142
Practice Address - Street 2:
Practice Address - City:PHILPOT
Practice Address - State:KY
Practice Address - Zip Code:42366-9334
Practice Address - Country:US
Practice Address - Phone:618-364-6349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1111762163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator