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General NPI Number Information
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NPI Number | 1902928898
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Entity Type | Organization
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Legal Business Name | LADIES CLINIC , PSC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 347 BOGLE ST STE A
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City | SOMERSET
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State | KY
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Zip | 42503-2873
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Country | US
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Telephone | 606-679-7353
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Fax |
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Provider Business Mailing Address
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Address Line | 347 BOGLE ST STE A
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City | SOMERSET
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State | KY
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Zip | 42503-2873
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Country | US
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Telephone | 606-679-7353
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DENNIS R FAULKNER
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Credential | MD
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Telephone | 606-679-7353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 1358P
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 5888P
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 23151
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License Number State | KY
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