Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 8254 | KY |
N | 213EG0000X | General Practice | 8254 | KY |
Y | 1223P0221X | Pediatric Dentist | 8254 | KY |
NPI | 1053439554 |
---|---|
Provider Name | Dr. Heather Hood Wise |
First Address | Campbellsville, KY 42718-9622 |
Second Address | Campbellsville, KY 42718-9622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 29/04/2008 |