Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 3002241 | KY |
NPI | 1033159827 |
---|---|
Provider Name | Jana Renee Gantley |
First Address | Morehead, KY 40351-1563 |
Second Address | Morehead, KY 40351-1563 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 07/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
78001237 | (05) | KY |
P23542 | (02) | KY |