| NPI | 1851998181 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARA NICOLE NETHERTON Practice Manager 502-212-0071 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 103T00000X Psychologist | |
| Enumeration Date | 2020-10-09 |
| Last Update Date | 2025-09-15 |