Healthcare Provider Details

I. General information

NPI: 1710173349
Provider Name (Legal Business Name): DIABETES CARE SOLUTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W STEPHEN FOSTER AVE SUITE 103
BARDSTOWN KY
40004-1465
US

IV. Provider business mailing address

120 W STEPHEN FOSTER AVE SUITE 103
BARDSTOWN KY
40004-1465
US

V. Phone/Fax

Practice location:
  • Phone: 502-349-0105
  • Fax: 502-349-0170
Mailing address:
  • Phone: 502-349-0105
  • Fax: 502-349-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number3072PKY
License Number StateKY

VIII. Authorized Official

Name: MRS. MARCIA JETT
Title or Position: OWNER
Credential: ARNP, CDE
Phone: 502-349-0105