Individual
MISS JILL DELANA SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
412 N LOCK AVE, LOUISA, KY 41230-1115
(606) 638-4595
Mailing address
606 LINCOLN AVE, PAINTSVILLE, KY 41240-1470
(606) 638-4595
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA442
KY
Other
Enumeration date
05/05/2008
Last updated
04/23/2010
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