| NPI | 1386904647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY GAST VP Managed Care 502-588-9490 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 170300000X Genetic Counselor, MS | |
| 2080S0010X Pediatrics, Sports Medicine | |
| 2083A0300X Preventive Medicine, Addiction Medicine | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 2251X0800X Physical Therapist, Orthopedic | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 363LA2100X Nurse Practitioner, Acute Care | |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2023-08-15 |