Healthcare Provider Details

I. General information

NPI: 1134318173
Provider Name (Legal Business Name): LESLEY P ABBOTT, DO, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 BELLEFONTE RD SUITE B
FLATWOODS KY
41139-2005
US

IV. Provider business mailing address

903 BELLEFONTE RD SUITE B
FLATWOODS KY
41139-2005
US

V. Phone/Fax

Practice location:
  • Phone: 606-836-0165
  • Fax:
Mailing address:
  • Phone: 606-836-0165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02808
License Number StateKY

VIII. Authorized Official

Name: MARY L CAUDILL
Title or Position: OFFICE MANAGER
Credential:
Phone: 606-836-0165