Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 03474 | KY |
Y | 207Q00000X | Family Doctor | 03474 | KY |
NPI | 1245559632 |
---|---|
Provider Name | Antoinette Justice |
First Address | Pikeville, KY 41502-2917 |
Second Address | Pikeville, KY 41501-1518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2010 |
Last Update Date | 11/07/2014 |