| NPI | 1891542718 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY GAST VP Managed Care 502-272-5335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 208000000X Pediatrics | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2024-04-30 |
| Last Update Date | 2024-10-16 |