Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3008047 | KY |
NPI | 1528407715 |
---|---|
Provider Name | Roberta L. York |
First Address | Corbin, KY 40701-2735 |
Second Address | Gray, KY 40734-4536 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2013 |
Last Update Date | 30/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100280890 | (05) | KY |