=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689241069
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTIE A BYLER LCPM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2021
-----------------------------------------------------
Last Update Date | 06/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6820 KY HIGHWAY 643
-----------------------------------------------------
City | CRAB ORCHARD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40419-8936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-749-5845
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6820 KY HIGHWAY 643
-----------------------------------------------------
City | CRAB ORCHARD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40419-8936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | 9000025
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------