NPI | 1306983762 |
---|---|
Entity Type | Organization |
Authorized Contact | SHELLEY GAST VP Managed Care 502-588-9490 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
103TC0700X Psychologist, Clinical | |
261Q00000X Clinic/Center | |
261QU0200X Clinic/Center, Urgent Care | |
363A00000X Physician Assistant | |
363AM0700X Physician Assistant, Medical | |
363AS0400X Physician Assistant, Surgical | |
363L00000X Nurse Practitioner | |
363LA2100X Nurse Practitioner, Acute Care | |
363LA2200X Nurse Practitioner, Adult Health | |
363LF0000X Nurse Practitioner, Family | |
363LP0200X Nurse Practitioner, Pediatrics | |
Enumeration Date | 2007-02-01 |
Last Update Date | 2023-04-03 |