Provider Demographics
NPI:1316948250
Name:SUBLETT, DONNA L (APRN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:SUBLETT
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 1:811 E PARRISH AVE
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3258
Mailing Address - Country:US
Mailing Address - Phone:270-688-3371
Mailing Address - Fax:270-688-3370
Practice Address - Street 1:811 E PARRISH AVE
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3258
Practice Address - Country:US
Practice Address - Phone:270-688-3371
Practice Address - Fax:270-688-3370
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003527363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000617707OtherCOOP HEALTH BCBS #
KYP00473272OtherRR MEDICARE
KY0992319OtherMEDICARE
KY78006574Medicaid
KY000000586347OtherBCBS
KY000000586347OtherBCBS
KY78006574Medicaid