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General NPI Number Information
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NPI Number | 1164158937
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Entity Type | Organization
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Legal Business Name | MAGUET MEDICAL CENTER LLC
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 40 MOONBOW PLZ STE 1
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City | CORBIN
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State | KY
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Zip | 40701-8983
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Country | US
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Telephone | 606-215-3488
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Fax | 606-280-4015
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Provider Business Mailing Address
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Address Line | 40 MOONBOW PLZ STE 1
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City | CORBIN
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State | KY
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Zip | 40701-8983
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Country | US
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Telephone | 606-215-3488
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Fax | 606-280-4015
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Authorized Official
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Title or Position | OWNER
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Name | DEVONNA MAGUET
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Credential | APRN
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Telephone | 606-215-3488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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