Provider Demographics
NPI:1063948594
Name:LOUDERMILK, MADONNA L (APRN)
Entity type:Individual
Prefix:
First Name:MADONNA
Middle Name:L
Last Name:LOUDERMILK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 HOGUE RD
Mailing Address - Street 2:
Mailing Address - City:PINE KNOT
Mailing Address - State:KY
Mailing Address - Zip Code:42635-7003
Mailing Address - Country:US
Mailing Address - Phone:606-354-9444
Mailing Address - Fax:606-354-9449
Practice Address - Street 1:57 HOGUE RD
Practice Address - Street 2:
Practice Address - City:PINE KNOT
Practice Address - State:KY
Practice Address - Zip Code:42635-7003
Practice Address - Country:US
Practice Address - Phone:606-354-9444
Practice Address - Fax:606-354-9449
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011298363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily