Healthcare Provider Details

I. General information

NPI: 1952516197
Provider Name (Legal Business Name): SUZANN FENTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4192 WILDERNESS RD
MT. VERNON KY
40456
US

IV. Provider business mailing address

PO BOX 1390
CORBIN KY
40702-1390
US

V. Phone/Fax

Practice location:
  • Phone: 606-256-3923
  • Fax: 606-256-5622
Mailing address:
  • Phone: 606-523-5732
  • Fax: 606-523-5727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: