Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 32948 | KY |
Y | 207RA0401X | Internist - Addiction Medicine | 32948 | KY |
NPI | 1316965700 |
---|---|
Provider Name | Cheryl A. Mcclain |
First Address | Cincinnati, OH 45202-1459 |
Second Address | Lexington, KY 40504-2716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 13/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080161176 | RR MEDICARE PIN (01) | |
37903705 | MEDICAID LAB GROUP (01) | KY |
4000501 | MEDICARE LAB GROUP (01) | KY |
64329485 | (05) | KY |
CB5773 | RR MEDICARE GROUP (01) | |
G52110 | (02) |