| Organization Name: | SOUTHERN KENTUCKY MEDICAL ASSOCIATES, PSC |
| NPI Number: | 1821392515 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANGELA CUNDIFF-ROY (PRESIDENT) |
| Mailing Address: | 72 Joe T. Pettey Dr Russell Springs |
| State: | KY US |
| Postal Code: | 42642 |
| Phone Number: | 2708664357 |
| Fax Number: | |
| NPI Enumeration Date: | 01/10/2011 |
| NPI Last Update Date: | 02/14/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |