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NPI Code Detail

MEDICARE: MRS. MICHELLE MARTIN PAC

MEDICARE: MRS. MICHELLE MARTIN PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA686KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003859174
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELLE MARTIN PAC
Provider Business Mailing Address
First Line : PO BOX 330
Second Line :
City : STANFORD
State : KY
Zip : 40484-0330
Country : US
Telephone Number : 606-365-1547
Fax Number : 606-365-8380
Provider Business Practice Location Address
First Line : 100 JAY STREET
Second Line :
City : STANFORD
State : KY
Zip : 40484-7511
Country : US
Telephone Number : 606-365-1547
Fax Number : 606-365-8380
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. MICHELLE MARTIN PAC” Practice Location

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