Healthcare Provider Details

I. General information

NPI: 1720036429
Provider Name (Legal Business Name): ANNANDLEE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 PATRIOT DRIVE SUITE 102
BARDSTOWN KY
40004
US

IV. Provider business mailing address

118 PATRIOT DRIVE SUITE 102
BARDSTOWN KY
40004
US

V. Phone/Fax

Practice location:
  • Phone: 502-350-1022
  • Fax: 502-350-1023
Mailing address:
  • Phone: 502-350-1022
  • Fax: 502-350-1023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES W PARRISH
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 502-350-1022