Provider Demographics
NPI:1669429593
Name:SKINNER, CONNIE J (ARNP)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:J
Last Name:SKINNER
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:PO BOX 795
Mailing Address - Street 2:7139 ST RT 56 E
Mailing Address - City:SEBREE
Mailing Address - State:KY
Mailing Address - Zip Code:42455-0009
Mailing Address - Country:US
Mailing Address - Phone:270-835-2000
Mailing Address - Fax:270-835-2204
Practice Address - Street 1:7139 HWY 56E
Practice Address - Street 2:
Practice Address - City:SEBREE
Practice Address - State:KY
Practice Address - Zip Code:42455-0009
Practice Address - Country:US
Practice Address - Phone:270-835-2200
Practice Address - Fax:270-835-2204
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3510P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78005683Medicaid
KY000000492913OtherBCBS
KY000000520903OtherBCBS
KYP00471564OtherRR MEDICARE
KY339774Medicare PIN
KY000000520903OtherBCBS
KY0992311Medicare PIN