| NPI | 1558521179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNETTA TRAYLOR Administrator 502-596-6063 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207RC0000X Internal Medicine Cardiovascular Disease | |
| 207RG0100X Internal Medicine Gastroenterology | |
| 207RP1001X Internal Medicine Pulmonary Disease | |
| 207V00000X Obstetrics & Gynecology | |
| 207X00000X Orthopaedic Surgery | |
| 207Y00000X Otolaryngology | |
| 208000000X Pediatrics | |
| 208600000X Surgery (Licence: TX G5232) | |
| 208800000X Urology | |
| 363LF0000X Nurse Practitioner Family | |
| 363LP0200X Nurse Practitioner Pediatrics | |
| 363LW0102X Nurse Practitioner Women's Health | |
| 367A00000X Advanced Practice Midwife | |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2025-08-06 |