Individual
MRS. SUZANNE MICHELLE FERNBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
405 VIOLET RD, CRITTENDEN, KY 41030-8956
(859) 903-0268
(859) 428-1444
Mailing address
PO BOX 635283, CINCINNATI, OH 45263-5283
(859) 903-0268
(889) 428-1444
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10002914A
IN
363A00000X
Physician Assistant
Primary
PA646
KY
363AM0700X
Medical Physician Assistant
PA646
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95002804
—
KY
Enumeration date
10/06/2006
Last updated
08/26/2022
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