Individual
J COLLEEN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP, APRN
Contact information
Practice address
713 W MAIN ST, ELKTON, KY 42220-9229
(270) 265-5353
(270) 265-5350
Mailing address
713 W MAIN ST, ELKTON, KY 42220-9229
(270) 265-5353
(270) 265-5350
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
3003040
KY
364SP0200X
Pediatric Clinical Nurse Specialist
3040P
KY
Other
Enumeration date
07/20/2007
Last updated
03/07/2023
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