Healthcare Provider Details

I. General information

NPI: 1467493882
Provider Name (Legal Business Name): GAYLE DENHAM PHD, PMHNP, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 E MAIN ST
STANFORD KY
40484-1339
US

IV. Provider business mailing address

1472 GREASY RIDGE RD
STANFORD KY
40484-7714
US

V. Phone/Fax

Practice location:
  • Phone: 606-365-7007
  • Fax: 606-365-7001
Mailing address:
  • Phone: 606-669-1507
  • Fax: 606-365-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2829P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: