Provider Demographics
NPI:1831220508
Name:BAUMGARDNER, MARY BETH (BA)
Entity type:Individual
Prefix:PROF
First Name:MARY
Middle Name:BETH
Last Name:BAUMGARDNER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:BAUMGARDNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1363
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-4363
Mailing Address - Country:US
Mailing Address - Phone:606-483-0729
Mailing Address - Fax:606-638-3003
Practice Address - Street 1:812 TOWN HILL RD
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-6396
Practice Address - Country:US
Practice Address - Phone:606-483-0729
Practice Address - Fax:606-638-3003
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management