Provider Demographics
NPI:1952767717
Name:WADDLE, LAUREN WEBB (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:WEBB
Last Name:WADDLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:NICOLE
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:301 VERSAILLES RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-3633
Mailing Address - Country:US
Mailing Address - Phone:502-352-2310
Mailing Address - Fax:
Practice Address - Street 1:301 VERSAILLES RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-3633
Practice Address - Country:US
Practice Address - Phone:502-352-2310
Practice Address - Fax:502-352-2311
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010015363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK149990OtherMEDICARE
KY71100398030Medicaid