Individual
MRS. MICHELLE MARTIN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
100 JAY STREET, STANFORD, KY 40484-7511
(606) 365-1547
(606) 365-8380
Mailing address
PO BOX 330, STANFORD, KY 40484-0330
(606) 365-1547
(606) 365-8380
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA686
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9500353900
—
KY
Enumeration date
06/14/2006
Last updated
07/08/2007
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