Healthcare Provider Details

I. General information

NPI: 1538406103
Provider Name (Legal Business Name): HELEN DEVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 STATE ROUTE 69 N
HARTFORD KY
42347-9785
US

IV. Provider business mailing address

500 STATE ROUTE 69 N
HARTFORD KY
42347-9785
US

V. Phone/Fax

Practice location:
  • Phone: 270-298-4415
  • Fax: 270-298-4438
Mailing address:
  • Phone: 270-298-4415
  • Fax: 270-298-4438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number1014567 3979P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: