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NPI Code Detail

MEDICARE: WYNNA KAY TABB

MEDICARE: WYNNA KAY TABB
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
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1811540131
Entity Type Code : Individual
Provider Name (Legal Business Name) : WYNNA KAY TABB
Provider Business Mailing Address
First Line : 915 MEMORIAL CT
Second Line :
City : ELIZABETHTOWN
State : KY
Zip : 42701-2525
Country : US
Telephone Number : 270-982-4200
Fax Number : 270-982-4201
Provider Business Practice Location Address
First Line : 915 MEMORIAL CT
Second Line :
City : ELIZABETHTOWN
State : KY
Zip : 42701-2525
Country : US
Telephone Number : 270-982-4200
Fax Number : 270-982-4201
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2019
Last Update Date : 02/23/2026

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Directions to “ WYNNA KAY TABB ” Practice Location

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