Healthcare Provider Details

I. General information

NPI: 1336617968
Provider Name (Legal Business Name): PHOEBE ANN WHEELERCRUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WOODHILL LN STE 6
FRANKFORT KY
40601-4219
US

IV. Provider business mailing address

140 WESLEY CT
RICHMOND KY
40475-8173
US

V. Phone/Fax

Practice location:
  • Phone: 855-591-0092
  • Fax:
Mailing address:
  • Phone: 859-200-7760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: