Provider Demographics
NPI:1972932176
Name:WOMEN'S HEALTH OF WESTERN KENTUCKY LLC
Entity type:Organization
Organization Name:WOMEN'S HEALTH OF WESTERN KENTUCKY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUSTAFSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-707-2100
Mailing Address - Street 1:PO BOX 2400
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241-2400
Mailing Address - Country:US
Mailing Address - Phone:270-707-2100
Mailing Address - Fax:270-707-2103
Practice Address - Street 1:112 KEETON DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-8756
Practice Address - Country:US
Practice Address - Phone:270-886-7427
Practice Address - Fax:270-885-7786
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JENNIE STUART MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty