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General NPI Number Information
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NPI Number | 1528334588
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Entity Type | Organization
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Legal Business Name | EAST KENTUCKY HEALTHCARE
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Dates
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Enumeration Date | 03/23/2012
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Last Update Date | 03/23/2012
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Provider Practice Location Address
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Address Line | 509 10TH ST
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City | PAINTSVILLE
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State | KY
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Zip | 41240-1200
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Country | US
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Telephone | 606-789-3797
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Fax |
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Provider Business Mailing Address
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Address Line | 509 10TH ST
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City | PAINTSVILLE
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State | KY
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Zip | 41240-1200
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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 | MEMBER
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Name | STEVEN WILLIAMS
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Credential |
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Telephone | 606-789-3797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1087509
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License Number State | KY
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