Organization Name: | GLENN R WOMACK MD PSC |
NPI Number: | 1003079781 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RAMONA L MITCHELL (CREDENTIALING) |
Mailing Address: | 732 Elizaville Rd Flemingsburg |
State: | KY US |
Postal Code: | 41041 |
Phone Number: | 6068492323 |
Fax Number: | 6068492025 |
NPI Enumeration Date: | 07/03/2008 |
NPI Last Update Date: | 07/03/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |