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General NPI Number Information
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NPI Number | 1942059381
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Entity Type | Individual
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Provider Name | MADISON PARDUE DYER
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Gender | Female
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Dates
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Enumeration Date | 05/17/2024
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 1225 FAIRWAY ST
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City | BOWLING GREEN
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State | KY
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Zip | 42103-2477
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Country | US
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Telephone | 270-781-3910
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Fax |
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Provider Business Mailing Address
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Address Line | 201 PARK ST
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City | BOWLING GREEN
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State | KY
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Zip | 42101-1708
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Country | US
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Telephone | 270-781-3910
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA3524
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License Number State | KY
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