Provider Demographics
NPI:1447281712
Name:MARPLE, VICKIE L (ARNP)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:L
Last Name:MARPLE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1196
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:42539-1196
Mailing Address - Country:US
Mailing Address - Phone:606-706-4265
Mailing Address - Fax:606-706-4275
Practice Address - Street 1:108 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539-3160
Practice Address - Country:US
Practice Address - Phone:606-706-4265
Practice Address - Fax:606-706-4275
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4478P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65907727Medicaid
KY65907727Medicaid