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SANDRA KAY JOHNSON GUESS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA C

Contact information

Practice address
2501 KENTUCKY AVE, PADUCAH, KY 42003-3813
(270) 217-1203
Mailing address
PO BOX 7044, PADUCAH, KY 42002-7044
(270) 217-1203

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 693
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000313069
ANTHEM BCBS
KY
05
95004685
KY
Enumeration date
10/04/2005
Last updated
04/29/2015
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