Healthcare Provider Details

I. General information

NPI: 1255471561
Provider Name (Legal Business Name): REBECCA J MCQUINN BS, PE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA J MIRACLE

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BEASLEY ST
LEXINGTON KY
40509-4266
US

IV. Provider business mailing address

350 RADIO PARK DR STE 1
RICHMOND KY
40475-2346
US

V. Phone/Fax

Practice location:
  • Phone: 859-358-5369
  • Fax:
Mailing address:
  • Phone: 859-358-5369
  • Fax: 859-254-2743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: