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General NPI Number Information
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NPI Number | 1497414478
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Entity Type | Individual
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Provider Name | IRELAND FALCONBERRY
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Gender | Female
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Dates
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Enumeration Date | 12/16/2021
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 828 LANE ALLEN RD
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City | LEXINGTON
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State | KY
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Zip | 40504-3658
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Country | US
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Telephone | 260-483-9081
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Fax |
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Provider Business Mailing Address
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Address Line | 2121 ROSS ST
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City | MADISON
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State | IN
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Zip | 47250-2659
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Country | US
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Telephone |
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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 | PA2850
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License Number State | KY
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