| NPI | 1902227937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAY CHARLES KENNEDY Medical Director 502-377-8138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2013-12-17 |
| Last Update Date | 2017-08-03 |