Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 34720 | KY |
N | 207VG0400X | Gynecologist | 35-073445 | OH |
NPI | 1124097787 |
---|---|
Provider Name | Dr. April Michelle Tillery |
First Address | Covington, KY 41017-0510 |
Second Address | Florence, KY 41042-4895 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 31/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
160051009 | RAILROAD MEDICARE (01) | OH |
2207749 | (05) | OH |
64016421 | (05) | KY |
H26917 | (02) | KY |