Provider Demographics
NPI:1558626317
Name:DEVINE, ABBY THOMPSON (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:THOMPSON
Last Name:DEVINE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:ELIZABETH
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:BUSINESS OFFICE - SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-543-3246
Mailing Address - Fax:502-543-3251
Practice Address - Street 1:1707 CEDAR GROVE RD STE 15
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-8572
Practice Address - Country:US
Practice Address - Phone:502-957-2084
Practice Address - Fax:502-657-1058
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007524363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100278480 (KOHMG)Medicaid
KYP01577187 RR (KOHMG)Medicare PIN
KYK058901 (KOHMG)Medicare PIN