Healthcare Provider Details

I. General information

NPI: 1891474193
Provider Name (Legal Business Name): NKY EARLY INTERVENTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6973 LUCIA DR
BURLINGTON KY
41005-6577
US

IV. Provider business mailing address

6973 LUCIA DR
BURLINGTON KY
41005-6577
US

V. Phone/Fax

Practice location:
  • Phone: 859-628-9805
  • Fax:
Mailing address:
  • Phone: 859-628-9805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: AMY WRIGHT
Title or Position: D.I.
Credential:
Phone: 859-628-9805