Individual
ELLEN DIVAS WEBB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
220 FRANKFORT ST, SUITE 2, VERSAILLES, KY 40383
(859) 873-0905
(859) 873-1025
Mailing address
220 FRANKFORT ST, SUITE 2, VERSAILLES, KY 40383-1079
(859) 873-0905
(859) 873-1025
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24998
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0905208
—
KY
05
—
64001340
—
KY
Enumeration date
12/19/2005
Last updated
06/26/2018
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