Provider Demographics
NPI:1720115421
Name:O'NEAL, MOLLY B (DNP/ARNP)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:B
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:DNP/ARNP
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:J
Other - Last Name:BRADSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP/ARNP
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-858-6655
Mailing Address - Fax:270-858-4607
Practice Address - Street 1:197 WILL WALKER ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728
Practice Address - Country:US
Practice Address - Phone:270-384-9981
Practice Address - Fax:270-384-9989
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005094363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3005094OtherAPRN LICENSE
KY7100502240Medicaid