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General NPI Number Information
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NPI Number | 1174018964
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Entity Type | Individual
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Provider Name | HANNAH GAINES SUTHERLAND M.A.
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Gender | Female
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 09/14/2018
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Provider Practice Location Address
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Address Line | 735 NORTH DR
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-2620
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Country | US
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Telephone | 270-886-5163
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Fax |
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Provider Business Mailing Address
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Address Line | 2642 CHANDLER DR APT 1821
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City | BOWLING GREEN
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State | KY
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Zip | 42104-6257
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Country | US
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Telephone | 859-494-9343
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 244532
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License Number State | KY
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