1699937730 NPI number — DR. LEIGH ANN GUNNELL D.M.D

Table of content: DR. LEIGH ANN GUNNELL D.M.D (NPI 1699937730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699937730 NPI number — DR. LEIGH ANN GUNNELL D.M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUNNELL
Provider First Name:
LEIGH
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699937730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 690
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEATTYVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41311-0690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-464-0151
Provider Business Mailing Address Fax Number:
606-464-0152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
672 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST LIBERTY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41472-1018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-743-3030
Provider Business Practice Location Address Fax Number:
606-743-7480
Provider Enumeration Date:
06/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  7909 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7909 . This is a "LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 31000862 . This is a "JUNIPER HEALTH FACILITY MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100056720 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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