Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 3309 |
NPI | 1003194648 |
---|---|
Provider Name | Mrs. Andrea C Coates |
First Address | Lexington, KY 40511-1275 |
Second Address | Lexington, KY 40511-1275 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2011 |
Last Update Date | 01/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1790731081 | (05) | KY |