Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 58169 | KY |
NPI | 1013514421 |
---|---|
Provider Name | Mr. Todd A Adams |
First Address | Wilmore, KY 40390-1075 |
Second Address | Prescott Valley, AZ 86314-1213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2020 |
Last Update Date | 08/10/2020 |