NPI | 1780004788 |
---|---|
Entity Type | Organization |
Authorized Contact | SHELLEY GAST VP Managed Care 502-272-5335 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine |
Additional Taxonomies | 207R00000X Internal Medicine |
207V00000X Obstetrics & Gynecology | |
207X00000X Orthopaedic Surgery | |
363L00000X Nurse Practitioner | |
363LF0000X Nurse Practitioner, Family | |
Enumeration Date | 2014-04-17 |
Last Update Date | 2023-11-07 |