Provider Demographics
NPI:1174764385
Name:ADAMS, CHARLOTTE LEAH (APRN-BC, MSN)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:LEAH
Last Name:ADAMS
Suffix:
Gender:F
Credentials:APRN-BC, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1032
Mailing Address - Country:US
Mailing Address - Phone:502-348-9206
Mailing Address - Fax:502-348-6485
Practice Address - Street 1:331 S 3RD ST
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1032
Practice Address - Country:US
Practice Address - Phone:502-348-9206
Practice Address - Fax:502-348-6485
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5075P363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health