Basic Information
| Provider Information | |||||||||
| NPI: | 1144948027 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANNING | ||||||||
| FirstName: | PEYTON | ||||||||
| MiddleName: | |||||||||
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| Credential: | PSS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1203 CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421012681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593386661 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 640 WRIGHT AVE | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421031623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667554258 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2022 | ||||||||
| LastUpdateDate: | 08/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | KY | Y |
No ID Information.