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General NPI Number Information
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NPI Number | 1679573208
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Entity Type | Individual
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Provider Name | SALLY WADDLE MCGEEHAN NP
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Gender | Female
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 06/03/2010
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Provider Practice Location Address
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Address Line | 9800 SHELBYVILLE RD SUITE #220
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City | LOUISVILLE
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State | KY
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Zip | 40223-2977
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Country | US
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Telephone | 502-429-8585
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Fax | 502-753-0889
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Provider Business Mailing Address
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Address Line | 206 E OAK ST
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City | SOMERSET
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State | KY
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Zip | 42501-1421
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Country | US
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Telephone | 606-678-0783
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 298P
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License Number State | KY
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