Individual
DR. TASHA M RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O
Contact information
Practice address
64 KIRK PLZ, INEZ, KY 41224
(606) 298-2520
(606) 298-2522
Mailing address
PO BOX 697, PRESTONSBURG, KY 41653-0697
(606) 298-2520
(606) 298-2522
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
03700
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100248940
—
KY
Enumeration date
05/16/2011
Last updated
06/25/2018
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