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General NPI Number Information
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NPI Number | 1649525999
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Entity Type | Individual
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Provider Name | ANDREA MARIE GREGORY KCSFA
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Gender | Female
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 07/23/2012
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Provider Practice Location Address
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Address Line | 275 HIGHWAY 770
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City | CORBIN
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State | KY
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Zip | 40701-4732
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Country | US
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Telephone | 606-526-7874
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Fax | 606-526-7836
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Provider Business Mailing Address
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Address Line | 221 PATTERSON RD
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City | LONDON
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State | KY
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Zip | 40744-9025
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Country | US
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Telephone | 606-682-4112
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | SA240
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License Number State | KY
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