Provider Demographics
NPI:1528148749
Name:ABELL, DOMINIQUE RENEE (APRN)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:RENEE
Last Name:ABELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:RENEE
Other - Last Name:BECKUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7840
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:4359 NEW SHEPHERDSVILLE RD UNIT 100
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-8002
Practice Address - Country:US
Practice Address - Phone:502-350-5700
Practice Address - Fax:502-350-5701
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4964P363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7801829800Medicaid