Healthcare Provider Details

I. General information

NPI: 1306049135
Provider Name (Legal Business Name): MRS. BETH GAIL STURGEON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1934 WHITNEY WOODS RD
CAVE CITY KY
42127
US

IV. Provider business mailing address

1934 WHITNEY WOODS RD
CAVE CITY KY
42127
US

V. Phone/Fax

Practice location:
  • Phone: 270-646-6783
  • Fax: 270-773-8626
Mailing address:
  • Phone: 270-646-6783
  • Fax: 270-773-8626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number1959
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: