Provider Demographics
NPI:1073320453
Name:PISCATELLE, GINA (APRN)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:
Last Name:PISCATELLE
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 1:2601 KENTUCKY AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3826
Mailing Address - Country:US
Mailing Address - Phone:270-575-3113
Mailing Address - Fax:
Practice Address - Street 1:2601 KENTUCKY AVE STE 301
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3826
Practice Address - Country:US
Practice Address - Phone:270-575-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4026848363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty