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General NPI Number Information
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NPI Number | 1053415760
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Entity Type | Individual
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Provider Name | SUSAN MICHELE PELL ATC, PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 09/08/2010
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Provider Practice Location Address
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Address Line | 350 HOSPITAL WAY SUITE 100
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City | SOMERSET
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State | KY
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Zip | 42503-2872
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Country | US
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Telephone | 606-451-2628
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Fax | 606-451-2630
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Provider Business Mailing Address
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Address Line | 350 HOSPITAL WAY SUITE 100
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City | SOMERSET
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State | KY
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Zip | 42503-2872
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Country | US
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Telephone | 606-451-2628
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Fax | 606-451-2630
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 001161
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | TC032
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License Number State | KY
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