Provider Demographics
NPI:1700885266
Name:DOBNER, BEVERLY VANCE (ARNP)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:VANCE
Last Name:DOBNER
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 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4 PHYSICIANS PARK
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4181
Practice Address - Country:US
Practice Address - Phone:502-223-8400
Practice Address - Fax:502-875-3073
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1032028163W00000X
KY3002674363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78026747Medicaid
IN201076430Medicaid
KY78026747Medicaid
KY0693105Medicare PIN
IN201076430Medicaid