Organization
LADIES CLINIC , PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS R FAULKNER MD (PRESIDENT)
(606) 679-7353
Entity
Organization
Contact information
Practice address
347 BOGLE ST STE A, SOMERSET, KY 42503-2873
(606) 679-7353
Mailing address
347 BOGLE ST STE A, SOMERSET, KY 42503-2873
(606) 679-7353
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
23151
KY
363LW0102X
Women's Health Nurse Practitioner
1358P
KY
363LW0102X
Women's Health Nurse Practitioner
5888P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64231517
—
KY
01
—
7423
MEDICARE PTAN
KY
Enumeration date
04/04/2007
Last updated
03/12/2009
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