Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | TP304 | KY |
NPI | 1992142632 |
---|---|
Provider Name | Jessica Marshall |
First Address | Bardstown, KY 40004-1299 |
Second Address | Bardstown, KY 40004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2013 |
Last Update Date | 30/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0120604 | (05) | OH |