Provider Demographics
NPI:1861536781
Name:DONNA S. NALL, MD, PSC
Entity type:Organization
Organization Name:DONNA S. NALL, MD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:NALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-679-8696
Mailing Address - Street 1:402 BOGLE ST
Mailing Address - Street 2:STE #1
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2870
Mailing Address - Country:US
Mailing Address - Phone:606-679-8696
Mailing Address - Fax:606-678-2517
Practice Address - Street 1:402 BOGLE ST
Practice Address - Street 2:STE #1
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2870
Practice Address - Country:US
Practice Address - Phone:606-679-8696
Practice Address - Fax:606-678-2517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21433207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC-69913Medicare UPIN
KY1518401Medicare ID - Type UnspecifiedMEDICARE