Healthcare Provider Details

I. General information

NPI: 1619382918
Provider Name (Legal Business Name): ELIZABETH DIANN DUNN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S 12TH ST
MURRAY KY
42071-9303
US

IV. Provider business mailing address

280 BALTIMORE CHURCH RD
MAYFIELD KY
42066-8109
US

V. Phone/Fax

Practice location:
  • Phone: 270-759-9200
  • Fax: 270-759-9966
Mailing address:
  • Phone: 270-804-1918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1896
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: