Provider Demographics
NPI:1215991567
Name:GENTRY, LINDA G (APRN)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:G
Last Name:GENTRY
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:PO BOX 996
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-0996
Mailing Address - Country:US
Mailing Address - Phone:859-813-4149
Mailing Address - Fax:859-545-4979
Practice Address - Street 1:213 SAINT CLAIR ST STE 205
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-1845
Practice Address - Country:US
Practice Address - Phone:859-813-4149
Practice Address - Fax:859-545-4979
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1076608163WP0809X
KY3004767363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3004767OtherKY BOARD OF NURSING
KY1076608OtherKY BOARD OF NURSING
KY7100080690Medicaid