Provider Demographics
NPI:1992066559
Name:MAGUET, DEVONNA GILES (APRN)
Entity type:Individual
Prefix:
First Name:DEVONNA
Middle Name:GILES
Last Name:MAGUET
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DEVONNA
Other - Middle Name:GILES
Other - Last Name:DURHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:219 WOODCHASE LN
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-8112
Mailing Address - Country:US
Mailing Address - Phone:606-521-5159
Mailing Address - Fax:
Practice Address - Street 1:40 MOONBOW PLZ STE 1
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8983
Practice Address - Country:US
Practice Address - Phone:606-215-3488
Practice Address - Fax:606-280-4015
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK103140OtherMEDICARE
KY7100301900Medicaid
KY00259OtherMEDICARE PTAN ASSOCIATED WITH OFFICE NPI NUMBER 1386781789