MEDICARE: MRS. BETH GAIL STURGEON

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
1	171M00000X	Case Manager/Care Coordinator	1959	KY

General Provider Information

NPI Number	:	1306049135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETH GAIL STURGEON

Provider Business Mailing Address
First Line	:	1934 WHITNEY WOODS RD
Second Line	:
City	:	CAVE CITY
State	:	KY
Zip	:	42127
Country	:	US
Telephone Number	:	270-646-6783
Fax Number	:	270-773-8626

Provider Business Practice Location Address
First Line	:	1934 WHITNEY WOODS RD
Second Line	:
City	:	CAVE CITY
State	:	KY
Zip	:	42127
Country	:	US
Telephone Number	:	270-646-6783
Fax Number	:	270-773-8626

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	07/08/2007

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