Provider Demographics
NPI:1346721271
Name:MARTIN, GERRI (APRN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:GERRI
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12579 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:KY
Mailing Address - Zip Code:41649-7400
Mailing Address - Country:US
Mailing Address - Phone:606-285-0681
Mailing Address - Fax:606-285-9843
Practice Address - Street 1:12579 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649-7400
Practice Address - Country:US
Practice Address - Phone:606-285-0681
Practice Address - Fax:606-285-9843
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1132893163W00000X, 163WC0200X, 163WG0000X
KY3012826363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner