Healthcare Provider Details

I. General information

NPI: 1780828871
Provider Name (Legal Business Name): ALLERGY AND ASTHMA CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 KENTUCKY AVE
PADUCAH KY
42003-3244
US

IV. Provider business mailing address

PO BOX 16475
CHAPEL HILL NC
27516-6475
US

V. Phone/Fax

Practice location:
  • Phone: 270-442-5151
  • Fax:
Mailing address:
  • Phone: 919-967-6646
  • Fax: 919-967-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY RANKIN
Title or Position: PRESIDENT
Credential: MD
Phone: 270-442-5151