Healthcare Provider Details

I. General information

NPI: 1437938990
Provider Name (Legal Business Name): EMILY C PUCKETT LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 US HIGHWAY 68 W
BENTON KY
42025-7423
US

IV. Provider business mailing address

1145 MAGNESS RD
BENTON KY
42025-5562
US

V. Phone/Fax

Practice location:
  • Phone: 270-527-4526
  • Fax:
Mailing address:
  • Phone: 270-804-5634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number281905
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: