Individual
SALLY M WOOTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
927 KENTON STATION DR, MAYSVILLE, KY 41056-9617
(606) 759-0433
(606) 759-0058
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-5098
(615) 920-7906
(615) 920-8938
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
46724
KY
207RP1001X
Pulmonary Disease Physician
46724
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001087464
—
PA
05
—
1558306761
—
SC
05
—
7100269150
—
KY
01
—
AA31868989
MEDICARE PTAN
SC
Enumeration date
06/19/2006
Last updated
02/08/2024
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