| NPI | 1902264377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY GAST VP Managed Care 502-272-5335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC462) |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2021-09-21 |