| NPI | 1558727545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY GAST VP Managed Care 502-588-9490 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080P0208X Pediatrics Pediatric Infectious Diseases |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TC0700X Psychologist Clinical | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2016-01-07 |
| Last Update Date | 2023-04-03 |