Provider Demographics
NPI:1962695593
Name:OSBORNE, MICHELLE L (APRN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1313 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:KY
Mailing Address - Zip Code:42320-8957
Mailing Address - Country:US
Mailing Address - Phone:270-274-9928
Mailing Address - Fax:270-274-0134
Practice Address - Street 1:1313 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:KY
Practice Address - Zip Code:42320-8957
Practice Address - Country:US
Practice Address - Phone:270-274-9928
Practice Address - Fax:270-274-0134
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005288363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100029630Medicaid
IN300009748Medicaid
KY7100029630Medicaid