| NPI | 1033320882 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDY L. BULLOCK Director 606-256-7761 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 39587) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 35006) |
| 207R00000X Internal Medicine (Licence: KY 23990) | |
| 207R00000X Internal Medicine (Licence: KY 25335) | |
| 208000000X Pediatrics (Licence: KY 23990) | |
| 208000000X Pediatrics (Licence: KY 25335) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: KY 38737) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: KY 17410) | |
| 363A00000X Physician Assistant (Licence: KY PA861) | |
| 363L00000X Nurse Practitioner (Licence: KY 4217P) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2020-08-22 |