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Specialty details in registry · Owensboro, KY

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At a glance

3015 Autumn Lake Cv, Owensboro, KY 42303-4464

NPPES record updated Jun 21, 2022. Public records can lag behind changes at a practice.

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Practice location

3015 Autumn Lake Cv
Owensboro, KY 42303-4464

Professional details: NPI, taxonomy & registry record

NPI1629709704

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Registry details

Primary taxonomy: Specialty details in registry
Taxonomy code: 106S00000X
Enumeration date: Jun 21, 2022
Record updated: Jun 21, 2022

More registry details

Provider type: Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

106S00000X · Primary

Specialty details in registry

373H00000X

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

3015 Autumn Lake Cv
Owensboro, KY 42303-4464

Phone: (270) 314-7667

Mailing address

3015 AUTUMN LAKE CV

OWENSBORO, KY 423034464

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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