| NPI | 1518001437 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNIE GOSSMAN Practice Administrator 502-893-5502 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 50935) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2018-04-04 |