| NPI | 1316682800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINA WARREN Director Credentialing & Payor En. 502-381-3338 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology |
| Enumeration Date | 2022-04-29 |
| Last Update Date | 2024-02-06 |