Healthcare Provider Details

I. General information

NPI: 1891713442
Provider Name (Legal Business Name): REBECCA LANORA DRISKELL-MCCOY D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W THIRD ST.
HARDINSBURG KY
40143
US

IV. Provider business mailing address

PO BOX 429
HARDINSBURG KY
40143-0429
US

V. Phone/Fax

Practice location:
  • Phone: 270-756-7950
  • Fax: 270-756-7949
Mailing address:
  • Phone: 270-756-7950
  • Fax: 270-756-7949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7441
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7441
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: