Provider Demographics
NPI:1780123687
Name:MARKINS PSC
Entity type:Organization
Organization Name:MARKINS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATISHA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:MARKINS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-505-0073
Mailing Address - Street 1:1098 OTTER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:VINE GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:40175-1200
Mailing Address - Country:US
Mailing Address - Phone:270-505-0073
Mailing Address - Fax:
Practice Address - Street 1:1098 OTTER CREEK RD
Practice Address - Street 2:
Practice Address - City:VINE GROVE
Practice Address - State:KY
Practice Address - Zip Code:40175-1200
Practice Address - Country:US
Practice Address - Phone:270-505-0073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007523363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty