Justin McMillian

Individual provider Active NPI Peer Specialist · Tompkinsville, KY

NPI 1740658129 · NPPES record last updated Sep 2, 2015

Key facts

NPI
1740658129
Entity type
Individual (NPI type 1)
Primary specialty
Peer Specialist 175T00000X
Practice address
800 N Main St
Tompkinsville, KY 42167-1037
Phone
(270) 901-5000
Fax
(270) 487-5948
NPI assigned
Sep 2, 2015
Sex
Male
Sole proprietor
No

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)CodeLicenseStatePrimary
Peer Specialist 175T00000X Yes

Addresses

Primary practice location

800 N Main St
Tompkinsville, KY 42167-1037

Mailing address

380 Suwannee Trail St
Bowling Green, KY 42103-7956
Phone (270) 901-5000

Other providers in Tompkinsville, KY

All providers in Tompkinsville, KY · Peer Specialist in Kentucky

Sources for this page

Verify at the official NPI Registry.