Healthcare Provider Details

I. General information

NPI: 1023025384
Provider Name (Legal Business Name): MARY A ENGLE P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY FLANNERY P.A.-C

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 E MAIN ST
HAZARD KY
41701-1939
US

IV. Provider business mailing address

47 FIELDS LN
BUSY KY
41723-8849
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-1316
  • Fax: 606-435-0752
Mailing address:
  • Phone: 606-487-0868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number707
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: