Healthcare Provider Details

I. General information

NPI: 1043682339
Provider Name (Legal Business Name): RACHAEL ABBOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CUNNINGHAM WAY
DANVILLE KY
40422-8339
US

IV. Provider business mailing address

PO BOX 1429
MT WASHINGTON KY
40047-1429
US

V. Phone/Fax

Practice location:
  • Phone: 859-936-3511
  • Fax:
Mailing address:
  • Phone: 502-538-1055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7386
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: