Provider Demographics
NPI:1730701053
Name:PARTIN, MICHAEL C (DNP, APRN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:PARTIN
Suffix:
Gender:M
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 W FRAZIER AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1687
Mailing Address - Country:US
Mailing Address - Phone:270-250-4242
Mailing Address - Fax:
Practice Address - Street 1:363 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1270
Practice Address - Country:US
Practice Address - Phone:270-384-3939
Practice Address - Fax:270-384-3940
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1136923163W00000X
KY3014954363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100693950Medicaid
KY3014954OtherKBN