Individual
THERESIA RENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
200 CLINIC DR, MADISONVILLE, KY 42431-1661
(270) 825-7200
Mailing address
200 CLINIC DR, MADISONVILLE, KY 42431-1661
(270) 825-7200
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA195
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000107779
BCBS PROVIDER NUMBER
—
01
—
PA195
LICENSE
KY
Enumeration date
09/17/2006
Last updated
04/19/2011
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