Healthcare Provider Details

I. General information

NPI: 1427007236
Provider Name (Legal Business Name): DERMATOLOGY SPECIALISTS OF NORTHERN KENTUCKY PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215A THOMAS MORE PKWY
CRESTVIEW HILLS KY
41017-3498
US

IV. Provider business mailing address

215 THOMAS MORE PKWY STE A
CRESTVIEW HILLS KY
41017-3498
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-9588
  • Fax: 859-341-0078
Mailing address:
  • Phone: 859-341-9588
  • Fax: 859-341-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE A SNYDER
Title or Position: PRESIDENT
Credential: MD
Phone: 859-341-9588