Healthcare Provider Details

I. General information

NPI: 1457124539
Provider Name (Legal Business Name): HAILEY CUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL VILLAGE DR
EDGEWOOD KY
41017-3403
US

IV. Provider business mailing address

2822 PALMETTO CT
FLORENCE KY
41042-9053
US

V. Phone/Fax

Practice location:
  • Phone: 859-572-3617
  • Fax:
Mailing address:
  • Phone: 559-623-2492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: