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NPI Code Detail

MEDICARE: ALEAH BETH WALLINGFORD

MEDICARE: ALEAH BETH WALLINGFORD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA3599KY
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1790530269
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEAH BETH WALLINGFORD
Provider Business Mailing Address
First Line : 989 MEDICAL PARK DR
Second Line :
City : MAYSVILLE
State : KY
Zip : 41056-8750
Country : US
Telephone Number : 606-759-5311
Fax Number :
Provider Business Practice Location Address
First Line : 989 MEDICAL PARK DR
Second Line :
City : MAYSVILLE
State : KY
Zip : 41056-8750
Country : US
Telephone Number : 606-759-5311
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2024
Last Update Date : 02/03/2026

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