| NPI | 1164279089 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY GAST VP Managed Care 502-272-5339 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 207R00000X Internal Medicine | |
| 208D00000X General Practice | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| Enumeration Date | 2024-04-30 |
| Last Update Date | 2024-07-30 |