Healthcare Provider Details

I. General information

NPI: 1265453658
Provider Name (Legal Business Name): REBECCA DRISKELL-MCCOY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W THIRD ST
HARDINSBURG KY
40143
US

IV. Provider business mailing address

122 W THIRD ST P.O. BOX 429
HARDINSBURG KY
40143
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 Code261QD0000X
TaxonomyDental Clinic/Center
License Number7441
License Number StateKY

VIII. Authorized Official

Name: DR. REBECCA LANORA DRISKELL-MCCOY IV
Title or Position: OWNER/DENTIST
Credential:
Phone: 270-756-7950