Healthcare Provider Details

I. General information

NPI: 1609130558
Provider Name (Legal Business Name): JOSHUA ANDREW FIFE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N GARDENMILE RD
HENDERSON KY
42420-5543
US

IV. Provider business mailing address

151 N GARDENMILE RD
HENDERSON KY
42420-5543
US

V. Phone/Fax

Practice location:
  • Phone: 270-830-9186
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5522
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number02005070A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: