Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 02905 | KY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 02905 | KY |
N | 207QA0505X | Family Doctor - Adult Medicine | 02905 | KY |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 02905 | KY |
N | 207QS0010X | Family Doctor - Sports Medicine | 02905 | KY |
NPI | 1134231822 |
---|---|
Provider Name | Angela Yvonne Rice |
First Address | Manchester, KY 40962-6196 |
Second Address | Manchester, KY 40962-6345 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 16/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64102478 | (05) | KY |
I40857 | (02) | KY |