Individual
MARY ALICE DISSELKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2407 RING RD STE 108, ELIZABETHTOWN, KY 42701-5938
(270) 706-5787
(270) 706-5788
Mailing address
2407 RING RD STE 108, ELIZABETHTOWN, KY 42701-5938
(270) 706-5787
(270) 706-5788
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
KY
Other
Enumeration date
05/14/2019
Last updated
11/08/2023
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