| NPI | 1720032105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNETTA TRAYLOR AO 502-596-6063 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 207L00000X Anesthesiology |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| 2085B0100X Radiology Body Imaging | |
| 2085R0202X Radiology Diagnostic Radiology | |
| 208600000X Surgery | |
| 208D00000X General Practice | |
| 367500000X Nurse Anesthetist, Certified Registered | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2025-06-26 |