Healthcare Provider Details

I. General information

NPI: 1962530089
Provider Name (Legal Business Name): ANN K FARRER DPM PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 PEDRO WAY
WINCHESTER KY
40391-8354
US

IV. Provider business mailing address

172 PEDRO WAY
WINCHESTER KY
40391-8354
US

V. Phone/Fax

Practice location:
  • Phone: 859-745-7890
  • Fax: 859-745-7891
Mailing address:
  • Phone: 859-745-7890
  • Fax: 859-745-7891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00208
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number00208
License Number StateKY

VIII. Authorized Official

Name: ANN FARRER
Title or Position: PROVIDER
Credential: DPM
Phone: 859-745-7890