| 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 |