Provider Demographics
NPI:1801892500
Name:RINKER, GWENDOLYN HAYES (APRN)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:HAYES
Last Name:RINKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:GWENDOLYN
Other - Middle Name:S
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 950244
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0244
Mailing Address - Country:US
Mailing Address - Phone:502-953-4700
Mailing Address - Fax:502-776-8912
Practice Address - Street 1:2215 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40212-1033
Practice Address - Country:US
Practice Address - Phone:502-774-8631
Practice Address - Fax:502-776-8912
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003631363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000228753OtherANTHEM
KY78007598Medicaid
KY00714072Medicare PIN
KY000000228753OtherANTHEM
KY01022015Medicare PIN
KYP10437Medicare UPIN
KY01065014Medicare PIN
KY0795673Medicare PIN
KY01021018Medicare PIN