Healthcare Provider Details

I. General information

NPI: 1619006012
Provider Name (Legal Business Name): DONNA MICHELLE WARREN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2007
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PROFESSIONAL PARK
GLASGOW KY
42141
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 270-651-9696
  • Fax: 270-651-0385
Mailing address:
  • Phone: 270-864-1472
  • Fax: 270-864-1693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberKY40630
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: