Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3012299 | KY |
NPI | 1003301698 |
---|---|
Provider Name | Malissa Claudette Contreras |
First Address | Lexington, KY 40511-8799 |
Second Address | Lexington, KY 40511-8702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2018 |
Last Update Date | 26/06/2018 |