| NPI | 1043605959 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAY CHARLES KENNEDY Medical Director 502-377-8138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY KY28102) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA824) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2015-03-30 |