Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 244492 | KY |
NPI | 1558907063 |
---|---|
Provider Name | Mary Rogers |
First Address | Lexington, KY 40511-1981 |
Second Address | Lexington, KY 40511-1981 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2019 |
Last Update Date | 12/12/2019 |