Provider Demographics
NPI:1699117226
Name:AT YOUR DOOR MOBILE MEDICAL PLLC
Entity type:Organization
Organization Name:AT YOUR DOOR MOBILE MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-921-2963
Mailing Address - Street 1:340 CHAPEZE LN
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-8893
Mailing Address - Country:US
Mailing Address - Phone:502-921-2963
Mailing Address - Fax:502-921-2963
Practice Address - Street 1:340 CHAPEZE LN
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-8893
Practice Address - Country:US
Practice Address - Phone:502-921-2963
Practice Address - Fax:502-921-2963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004234363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty