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General NPI Number Information
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NPI Number | 1083236756
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Entity Type | Individual
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Provider Name | TAMARA MICHELE PRESCOTT CPT
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Gender | Female
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Dates
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Enumeration Date | 05/15/2020
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Last Update Date | 05/15/2020
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Provider Practice Location Address
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Address Line | 4611 N DIXIE HWY STE 100
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-8828
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Country | US
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Telephone | 502-369-1654
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Fax | 502-861-7287
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Provider Business Mailing Address
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Address Line | 740 SOUTHLAND DR
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City | RADCLIFF
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State | KY
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Zip | 40160-9606
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Country | US
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Telephone | 904-328-9788
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Fax | 502-861-7287
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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