=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285888792
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CURTINA LEIGH BELILES PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2008
-----------------------------------------------------
Last Update Date | 04/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 W ROBERTS ST
-----------------------------------------------------
City | MORGANTOWN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42261-7942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-526-3841
-----------------------------------------------------
Fax | 270-783-3759
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 PARK ST
-----------------------------------------------------
City | BOWLING GREEN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42101-1759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-526-3841
-----------------------------------------------------
Fax | 270-783-3759
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------