| NPI | 1972144590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY GAST Syst VP Of Mngd Care & Payor Strat 502-272-5335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080P0201X Pediatrics Pediatric Allergy/Immunology |
| Additional Taxonomies | 208000000X Pediatrics |
| 207K00000X Allergy & Immunology | |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant Medical | |
| 363AS0400X Physician Assistant Surgical | |
| 363L00000X Nurse Practitioner | |
| 363LP0200X Nurse Practitioner Pediatrics | |
| Enumeration Date | 2019-10-04 |
| Last Update Date | 2021-09-22 |