Provider Demographics
NPI:1285866301
Name:LUSK, DEBRA S (APRN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:S
Last Name:LUSK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:S
Other - Last Name:MAHURIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:4004 DUPONT CIR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4819
Mailing Address - Country:US
Mailing Address - Phone:502-893-0159
Mailing Address - Fax:502-213-3853
Practice Address - Street 1:910 WALLACE AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-2414
Practice Address - Country:US
Practice Address - Phone:270-259-3593
Practice Address - Fax:270-259-2714
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006006363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100124430Medicaid
KY7100124430Medicaid
KYK109150OtherMEDICARE
KYK109151Medicare PIN