MEDICARE: AVOL KENTUCKY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	405300000X	Prevention Professional

General Provider Information

NPI Number	:	1265223861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVOL KENTUCKY

Provider Business Mailing Address
First Line	:	1824 HILL RISE DR STE 100
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-2508
Country	:	US
Telephone Number	:	859-225-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1824 HILL RISE DR STE 100
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-2508
Country	:	US
Telephone Number	:	859-225-3000
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JON PARKER
Credential	:	MSW
Telephone Number	:	859-225-3000

Provider Enumeration Date	:	05/14/2025
Last Update Date	:	05/14/2025

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Directions to “AVOL KENTUCKY ” Practice Location

Language	Start Address	Practice Location

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