Individual
STUART G MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
215 N ALLISON AVE, BARBOURVILLE, KY 40906-1336
(606) 546-9287
(606) 546-9363
Mailing address
215 N ALLISON AVE, PO BOX 1150, BARBOURVILLE, KY 40906-1336
(606) 546-9287
(606) 546-9363
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1815
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100255350
—
KY
01
—
CS1631301477
HUMANA CARESOURCE
KY
Enumeration date
06/26/2013
Last updated
12/07/2018
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