| NPI | 1225333743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID A DAGEFORDE President 502-645-6817 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: KY LAL000152) |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363LA2100X Nurse Practitioner, Acute Care | |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2011-01-13 |
| Last Update Date | 2016-06-16 |