Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 29143 | KY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 29143 | KY |
N | 207QA0505X | Family Doctor - Adult Medicine | 29143 | KY |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 29143 | KY |
N | 207QS0010X | Family Doctor - Sports Medicine | 29143 | KY |
NPI | 1518079300 |
---|---|
Provider Name | Baretta R Casey |
First Address | Lexington, KY 40517-4012 |
Second Address | Hazard, KY 41701-9469 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 22/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64291438 | (05) | KY |
F36743 | (02) |