Healthcare Provider Details

I. General information

NPI: 1710142849
Provider Name (Legal Business Name): DELTA DAWN CARMAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 DANIEL DR
DANVILLE KY
40422-2527
US

IV. Provider business mailing address

1070 NORTH HIGHWAY 501
KINGS MOUNTAIN KY
40442
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-4686
  • Fax:
Mailing address:
  • Phone: 606-787-9858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberA02177
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: