Organization Name: | SOUTHERN KY MEDICAL ASSOCIATES |
NPI Number: | 1508196262 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANGELA CUNDIFF / ROY (CANP) |
Mailing Address: | 72 Joe T Petty Dr Russell Springs |
State: | KY US |
Postal Code: | 42718 |
Phone Number: | 2708664357 |
Fax Number: | 2708584957 |
NPI Enumeration Date: | 12/31/2009 |
NPI Last Update Date: | 12/31/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 364SA2200X |
License Number: | 2287P |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Clinical Nurse Specialist |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |