Avery Jea Martin
Individual provider Active NPI Nurse Practitioner · Crittenden, KY
NPI 1053967653 · NPPES record last updated Sep 24, 2020
Key facts
- NPI
- 1053967653
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 3013651 (KY)
- Practice address
- 405 Violet Rd
Crittenden, KY 41030-8956 - Phone
- (859) 428-1610
- Fax
- (859) 428-3923
- NPI assigned
- Aug 11, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APRN.CNP.024869 | OH | MD | Nurse Practitioner |
Interoperability endpoints
- amartin332705@direct-prd.stelizabeth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 3013651 | KY | Yes |
| Nurse Practitioner | 363L00000X | APRN.CNP.024869 | OH |
Addresses
Primary practice location
405 Violet Rd
Crittenden, KY 41030-8956
Mailing address
PO Box 635283
Cincinnati, OH 45263-5283
Other providers in Crittenden, KY
- Connie Kiser
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- John Francis Lenihan II
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- Miran H. McClendon
- Gary Jasper Melton
- Mary Milner
- Kathie E Morgan
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All providers in Crittenden, KY · Nurse Practitioner in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 24, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.