| NPI | 1023400629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY GAST VP Managed Care 502-588-9490 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2015-02-19 |
| Last Update Date | 2021-09-21 |