Provider Demographics
NPI:1740263805
Name:MYERS, ADRIA B (APRN)
Entity type:Individual
Prefix:MRS
First Name:ADRIA
Middle Name:B
Last Name:MYERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ADRIA
Other - Middle Name:B
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:UK DIVISION OF MEDICAL ONCOLOGY
Mailing Address - Street 2:800 ROSE STREET, CC401
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0093
Mailing Address - Country:US
Mailing Address - Phone:859-323-8043
Mailing Address - Fax:859-257-7715
Practice Address - Street 1:UK DIVISION OF MEDICAL ONCOLOGY
Practice Address - Street 2:800 ROSE STREET, CC401
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0093
Practice Address - Country:US
Practice Address - Phone:859-323-8043
Practice Address - Fax:859-257-7715
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004419363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78015518Medicaid
KY1513605Medicare ID - Type Unspecified
KY78015518Medicaid