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General NPI Number Information
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NPI Number | 1306828900
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Entity Type | Individual
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Provider Name | MARTY ROBERT LITCHFIELD P.A.
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Gender | Male
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 04/10/2019
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Provider Practice Location Address
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Address Line | 650 JOEL DR
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City | FORT CAMPBELL
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State | KY
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Zip | 42223-5318
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Country | US
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Telephone | 270-461-0309
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Fax |
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Provider Business Mailing Address
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Address Line | 4071 SINGLETREE DR
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-9191
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Country | US
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Telephone | 270-707-7170
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA0000001836
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License Number State | TN
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