Provider Demographics
NPI:1548441165
Name:SAVAGE, MICHELLE B
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:B
Last Name:SAVAGE
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 1:914 N DIXIE AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2537
Mailing Address - Country:US
Mailing Address - Phone:270-735-9066
Mailing Address - Fax:270-735-9036
Practice Address - Street 1:914 N DIXIE AVE STE 307
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2537
Practice Address - Country:US
Practice Address - Phone:270-735-9066
Practice Address - Fax:270-735-9036
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5408P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner