Individual
CHARITY DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
45 MOONBOW PLZ, CORBIN, KY 40701-8949
(606) 523-9010
(606) 528-0028
Mailing address
PO BOX 1325, CORBIN, KY 40702-1325
(606) 523-9010
(606) 523-0028
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3013049
KY
Other
Enumeration date
12/20/2018
Last updated
01/23/2019
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