Individual
GENIE SIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
KPSS
Contact information
Practice address
125 JORDANS WAY, SOMERSET, KY 42501-3166
(606) 772-0168
Mailing address
3651 HIGHWAY 2565, 2ND FLOOR, LOUISA, KY 41230-5018
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
04/29/2016
Last updated
04/29/2016
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