Individual
MRS. CHANTY LYNN HEADSPETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
906 WOODLAND DR, STE 102, ELIZABETHTOWN, KY 42701-2752
(270) 765-5127
(270) 765-2653
Mailing address
906 WOODLAND DR, STE 102, ELIZABETHTOWN, KY 42701-2752
(270) 765-5127
(270) 765-2653
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA541
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9500308300
—
KY
Enumeration date
07/29/2005
Last updated
02/09/2009
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