Organization
GATEWAY INTERNAL MEDICINE AND PEDIATRIC ASSOCIATES PLLC
Active
Other names
Gateway Internal Medicine and Pediatric Associates PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DONNA LYNN RAPER (PRACTICE MANAGER)
(859) 498-7715
Entity
Organization
Contact information
Practice address
103 COMMONWEALTH DRIVE, MT STERLING, KY 40353-9317
(859) 498-7716
(859) 497-0044
Mailing address
PO BOX 689, MT STERLING, KY 40353-0689
(859) 498-7716
(859) 497-0044
Taxonomy
Speciality
Code
Description
License number
State
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
Primary
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65934036
—
KY
Enumeration date
12/06/2006
Last updated
05/25/2012
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