| NPI | 1760583165 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY NOVAK Practice Manager 859-226-0031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2023-09-11 |