Healthcare Provider Details

I. General information

NPI: 1104087196
Provider Name (Legal Business Name): ST LUKE PEDIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 LANDMARK DR STE 360
BELLEVUE KY
41073-1354
US

IV. Provider business mailing address

103 LANDMARK DR STE 360
BELLEVUE KY
41073-1354
US

V. Phone/Fax

Practice location:
  • Phone: 859-261-3700
  • Fax: 859-261-9788
Mailing address:
  • Phone: 859-261-3700
  • Fax: 859-261-9788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEPHANIE SANCHEZ
Title or Position: CODER
Credential: CPC
Phone: 859-261-3700