Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 1088014 | KY |
NPI | 1043380363 |
---|---|
Provider Name | Mrs. Missy S Hawes |
First Address | Louisville, KY 40243-1882 |
Second Address | Louisville, KY 40243-1882 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 08/07/2007 |