| NPI | 1336771161 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY GAST Syst VP Mngd Care & Payor Strat 502-272-5335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NP0225X Dermatology Pediatric Dermatology |
| Additional Taxonomies | 207N00000X Dermatology |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner Family | |
| 363LP0200X Nurse Practitioner Pediatrics | |
| Enumeration Date | 2020-02-10 |
| Last Update Date | 2021-09-22 |