Healthcare Provider Details

I. General information

NPI: 1275857757
Provider Name (Legal Business Name): ABBIE HARTS GUTIERREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBIE NICOLE HARTS M.D.

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT JOSEPH DR
LEXINGTON KY
40504-3742
US

IV. Provider business mailing address

1375 ROSE LN
VERSAILLES KY
40383-9760
US

V. Phone/Fax

Practice location:
  • Phone: 859-313-1176
  • Fax:
Mailing address:
  • Phone: 901-233-2560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301096709
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number47446
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: