Provider Demographics
NPI:1831923713
Name:CHAMPION, HANNAH NICOLE
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:NICOLE
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11320 BUFFALO ROAD
Mailing Address - Street 2:
Mailing Address - City:GRACEY
Mailing Address - State:KY
Mailing Address - Zip Code:42232
Mailing Address - Country:US
Mailing Address - Phone:270-484-7284
Mailing Address - Fax:
Practice Address - Street 1:10755 EAGLE WAY STE 100
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-8742
Practice Address - Country:US
Practice Address - Phone:270-887-0270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-31
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4025382363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily