Healthcare Provider Details

I. General information

NPI: 1881689693
Provider Name (Legal Business Name): PELL ANN WARDROP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N EAGLE CREEK DR STE 302
LEXINGTON KY
40509-2124
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-967-5044
  • Fax: 859-967-5041
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number23120
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number23120
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: