Individual
CONNOR GRANT EARLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
1 TRILLIUM WAY, CORBIN, KY 40701-8426
(606) 523-8514
Mailing address
PO BOX 881, BARBOURVILLE, KY 40906-0881
(606) 627-7651
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3016748
KY
363LF0000X
Family Nurse Practitioner
3016748
KY
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
09/01/2021
Last updated
11/08/2021
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