Provider Demographics
NPI:1962764357
Name:MCPHERSON, DEANNA (APRN)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:MCPHERSON
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 1:1200 BRECKENRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1089
Mailing Address - Country:US
Mailing Address - Phone:270-685-8230
Mailing Address - Fax:270-685-8233
Practice Address - Street 1:1200 BRECKENRIDGE ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1089
Practice Address - Country:US
Practice Address - Phone:270-685-8230
Practice Address - Fax:270-685-8233
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007113364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
2011010010OtherANCC
KY3007113OtherKBN