Provider Demographics
NPI:1740443050
Name:GAYHEART, GLENDA J
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:J
Last Name:GAYHEART
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:PO BOX 723
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:KY
Mailing Address - Zip Code:41141-0723
Mailing Address - Country:US
Mailing Address - Phone:606-757-3237
Mailing Address - Fax:
Practice Address - Street 1:8385 E KY8
Practice Address - Street 2:
Practice Address - City:VANCEBURG
Practice Address - State:KY
Practice Address - Zip Code:41179
Practice Address - Country:US
Practice Address - Phone:606-757-3237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency