Healthcare Provider Details

I. General information

NPI: 1730092727
Provider Name (Legal Business Name): LORD OF MY HEART PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 THOMAS MORE PKWY
CRESTVIEW HILLS KY
41017-3424
US

IV. Provider business mailing address

230 THOMAS MORE PKWY
CRESTVIEW HILLS KY
41017-3424
US

V. Phone/Fax

Practice location:
  • Phone: 301-300-7318
  • Fax: 859-545-5005
Mailing address:
  • Phone: 301-300-7318
  • Fax: 859-545-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES ROBERTS
Title or Position: OWNER
Credential:
Phone: 301-300-7318