Misty Wease
Individual provider Active NPI Substance Abuse Rehabilitation Facility · Magnolia, KY
NPI 1508607169 · NPPES record last updated Jun 5, 2024
Key facts
- NPI
- 1508607169
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Substance Abuse Rehabilitation Facility 324500000X
- Practice address
- 2396 Friendship Church Rd
Magnolia, KY 42757-7613 - Phone
- (270) 218-2652
- NPI assigned
- Jun 5, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Abuse Rehabilitation Facility | 324500000X | Yes |
Addresses
Primary practice location
2396 Friendship Church Rd
Magnolia, KY 42757-7613
Mailing address
2396 Friendship Church Rd
Magnolia, KY 42757-7613
Phone (270) 218-2652
Other providers in Magnolia, KY
All providers in Magnolia, KY · Substance Abuse Rehabilitation Facility in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.