Provider Demographics
NPI:1104888908
Name:GOLDEN, MARK A (ARNP)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:ARNP
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Mailing Address - Street 1:4071 TATES CREEK CENTRE DR
Mailing Address - Street 2:SUTIE 202
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3062
Mailing Address - Country:US
Mailing Address - Phone:606-528-9770
Mailing Address - Fax:606-528-9769
Practice Address - Street 1:60 S STEWART RD
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-4675
Practice Address - Country:US
Practice Address - Phone:606-528-9770
Practice Address - Fax:606-528-9769
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY3004618363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78015799Medicaid
KYP00884115OtherRR MEDICARE
KYP00884115OtherRR MEDICARE
KYQ63288Medicare UPIN
KY000000510922OtherANTHEM