Individual
MRS. PENNY ANN MEDICINEBEAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
224 SUNSET AVE, SMITHS GROVE, KY 41217
(270) 784-7079
Mailing address
PO BOX 433, SMITHS GROVE, KY 42171-0433
(270) 784-7079
(270) 451-1200
Taxonomy
Speciality
Code
Description
License number
State
344600000X
Taxi
Primary
3585
KY
344600000X
Taxi
3586
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3162
—
KY
Enumeration date
02/18/2011
Last updated
02/18/2011
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