Provider Demographics
NPI:1538675483
Name:MEDDERS, AIMEE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:
Last Name:MEDDERS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 192ND ARMOR TANK BATTALION RD RM 226
Mailing Address - Street 2:
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121-5116
Mailing Address - Country:US
Mailing Address - Phone:502-624-6158
Mailing Address - Fax:
Practice Address - Street 1:968 1ST INFANTRY DIVISION RD BLDG 2724
Practice Address - Street 2:
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121-5210
Practice Address - Country:US
Practice Address - Phone:502-626-8301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4770124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4770OtherRDH LICENSE