Provider Demographics
NPI:1588717961
Name:TODD, DANA M (FNP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:M
Last Name:TODD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 SLICKBACK RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-7629
Mailing Address - Country:US
Mailing Address - Phone:270-527-1496
Mailing Address - Fax:270-527-5321
Practice Address - Street 1:267 SLICKBACK RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-7629
Practice Address - Country:US
Practice Address - Phone:270-527-1496
Practice Address - Fax:270-527-5321
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2065P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20079018Medicaid
KY0227507Medicare PIN