Healthcare Provider Details

I. General information

NPI: 1215369905
Provider Name (Legal Business Name): THE WOMEN'S PAVILION, PSC APRN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E PARRISH AVE STE 201 BLDG B
OWENSBORO KY
42303-1449
US

IV. Provider business mailing address

2200 E PARRISH AVE STE 201 BLDG B
OWENSBORO KY
42303-1449
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-3700
  • Fax: 270-926-2114
Mailing address:
  • Phone: 270-926-3700
  • Fax: 270-926-2114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREA B MOORE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 270-926-3700