Basic Information
| Provider Information | |||||||||
| NPI: | 1972932176 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOMEN'S HEALTH OF WESTERN KENTUCKY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2400 | ||||||||
| Address2: | |||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422412400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707072100 | ||||||||
| FaxNumber: | 2707072103 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 KEETON DR | ||||||||
| Address2: | |||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422408756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708867427 | ||||||||
| FaxNumber: | 2708857786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2013 | ||||||||
| LastUpdateDate: | 11/07/2013 | ||||||||
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| AuthorizedOfficialLastName: | GUSTAFSON | ||||||||
| AuthorizedOfficialFirstName: | DARRELL | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2707072100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | JENNIE STUART MEDICAL CENTER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.