| NPI | 1346279510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA L EVANS Provider Enrollment Specialist 270-744-9600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 20596) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3007447) |
| 208000000X Pediatrics (Licence: KY 28040) | |
| 208000000X Pediatrics (Licence: KY 30516) | |
| 208000000X Pediatrics (Licence: KY 22172) | |
| 208000000X Pediatrics (Licence: KY 43274) | |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2013-08-05 |