Healthcare Provider Details

I. General information

NPI: 1871971820
Provider Name (Legal Business Name): NORTHERN KY INDEPENDENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 EASTERN AVE
COVINGTON KY
41014-1530
US

IV. Provider business mailing address

610 MEDICAL VILLAGE DR
EDGEWOOD KY
41017-3416
US

V. Phone/Fax

Practice location:
  • Phone: 859-491-9200
  • Fax:
Mailing address:
  • Phone: 859-341-4264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: SUSAN J LANDERS
Title or Position: SUPPORT SERVICES MANAGER
Credential:
Phone: 859-363-2040