Provider Demographics
NPI:1881974418
Name:DONAVAN, PSC
Entity type:Organization
Organization Name:DONAVAN, PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/APRN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BROUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:606-627-5565
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-0310
Mailing Address - Country:US
Mailing Address - Phone:606-627-0525
Mailing Address - Fax:606-546-4579
Practice Address - Street 1:726 S US HIGHWAY 25E
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7316
Practice Address - Country:US
Practice Address - Phone:606-627-0525
Practice Address - Fax:606-546-4579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006067P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty