Provider Demographics
NPI:1437854551
Name:DEHART, ELIZABETH AMANDA
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:AMANDA
Last Name:DEHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 GORMAN HOLLOW RD APT 132
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-2313
Mailing Address - Country:US
Mailing Address - Phone:606-705-1156
Mailing Address - Fax:
Practice Address - Street 1:182 ROY CAMPBELL DR
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9407
Practice Address - Country:US
Practice Address - Phone:606-435-0886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator