Individual
MARY G COUILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
627 SPRING HILL DR, EDDYVILLE, KY 42038-8759
(270) 388-9284
Mailing address
627 SPRING HILL DR, EDDYVILLE, KY 42038-8759
(270) 388-9284
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
41161
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000382438
ANTHEM 12 DIGIT UPIN
KY
Enumeration date
11/15/2005
Last updated
07/08/2007
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