Healthcare Provider Details

I. General information

NPI: 1508893819
Provider Name (Legal Business Name): VIRGINIA GABBARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 HIGHLAND AVE
CARROLLTON KY
41008-8775
US

IV. Provider business mailing address

502 FARRELL DR
COV KY
41011-3717
US

V. Phone/Fax

Practice location:
  • Phone: 502-732-9331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: