Individual
MRS. TRACEY GREGORY MAYNOR
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
4003 KRESGE WAY, #221, LOUISVILLE, KY 40207-4652
(502) 897-7107
(502) 897-7613
Mailing address
4003 KRESGE WAY, #221, LOUISVILLE, KY 40207-4652
(502) 897-7107
(502) 897-7613
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 549
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9500175600
—
KY
Enumeration date
07/18/2005
Last updated
07/08/2007
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