Healthcare Provider Details

I. General information

NPI: 1053729764
Provider Name (Legal Business Name): GRAVES COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 US HIGHWAY 60 E
BURNA KY
42028-9239
US

IV. Provider business mailing address

416 CENTRAL AVE
MAYFIELD KY
42066-3115
US

V. Phone/Fax

Practice location:
  • Phone: 270-247-3553
  • Fax: 270-247-0391
Mailing address:
  • Phone: 270-247-3553
  • Fax: 270-247-0391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LESLIE N NOLIN
Title or Position: SSSA III
Credential:
Phone: 270-247-3553