| NPI | 1669873881 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRANCE DILLON Assistant Secretary 502-596-7220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 207R00000X Internal Medicine | |
| 207RC0000X Internal Medicine, Cardiovascular Disease | |
| 207RI0011X Internal Medicine, Interventional Cardiology | |
| 208000000X Pediatrics | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2014-09-07 |
| Last Update Date | 2022-04-22 |