| NPI | 1770964363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNETTA TRAYLOR AO 502-596-6063 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 208000000X Pediatrics | |
| 363A00000X Physician Assistant | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2025-06-26 |