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General NPI Number Information
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NPI Number | 1760717516
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Entity Type | Organization
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Legal Business Name | PAMELA K HARSTON, MD, PLC
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Dates
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Enumeration Date | 10/13/2009
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Last Update Date | 11/12/2010
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Provider Practice Location Address
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Address Line | 1890 LYDA AVE SUITE 103
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City | BOWLING GREEN
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State | KY
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Zip | 42104-5829
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Country | US
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Telephone | 270-904-6160
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Fax | 270-904-6165
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Provider Business Mailing Address
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Address Line | 1890 LYDA AVE SUITE 103
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City | BOWLING GREEN
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State | KY
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Zip | 42104-5829
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Country | US
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Telephone | 270-904-6160
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Fax | 270-904-6165
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | PAMELA KAYE HARSTON
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Credential | MD
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Telephone | 270-904-6160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | KY25936
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License Number State | KY
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