Organization
GINKGO GARDEN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY COUILLARD PHD ARNP (OWNER)
(270) 362-5009
Entity
Organization
Contact information
Practice address
462 BARKLEY DR, GRAND RIVERS, KY 42045
(270) 362-5009
(928) 563-5009
Mailing address
462 BARKLEY DR, GRAND RIVERS, KY 42045
(270) 362-5009
(928) 563-5009
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
264207
KY
Other
Enumeration date
11/02/2006
Last updated
08/22/2020
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