Doctor Name: | MRS. MICHELLE MARTIN |
NPI Number: | 1003859174 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PAC |
License Number: | PA686 |
Business Practice Address: | 100 Jay Street Stanford, KY - 404847511 |
Business Phone Number: | 6063651547 |
Business Fax Number: | 6063658380 |
Mailing Address: | Po Box 330, STANFORD |
State: | KY |
Postal Code: | 404840330 |
Phone Number: | 6063651547 |
Fax Number: | 6063658380 |
NPI Enumeration Date: | 06/14/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA686 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |