Healthcare Provider Details

I. General information

NPI: 1487143806
Provider Name (Legal Business Name): FRESH START HEALTH PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 01/31/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 29TH ST STE 203
ASHLAND KY
41101-1932
US

IV. Provider business mailing address

336 29TH ST STE 203
ASHLAND KY
41101-1932
US

V. Phone/Fax

Practice location:
  • Phone: 606-225-8200
  • Fax: 888-606-7354
Mailing address:
  • Phone: 606-225-8200
  • Fax: 888-606-7354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JERREL BOYER
Title or Position: OWNER
Credential: DO
Phone: 606-225-8200