Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 2499P | KY |
NPI | 1083763700 |
---|---|
Provider Name | Melissa Joyce Owens |
First Address | Henderson, KY 42420-2712 |
Second Address | Henderson, KY 42420-2712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
78002318 | (05) | KY |