Healthcare Provider Details

I. General information

NPI: 1174528392
Provider Name (Legal Business Name): KENDALL E HANSEN MD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 THOMAS MORE PKWY. STE. 260
CRESTVIEW HILLS KY
41017-5117
US

IV. Provider business mailing address

PO BOX 634
FLORENCE KY
41022-0634
US

V. Phone/Fax

Practice location:
  • Phone: 859-957-0700
  • Fax: 859-957-0703
Mailing address:
  • Phone: 859-957-0700
  • Fax: 859-957-0703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: KENDALL E. HANSEN
Title or Position: M.D., PRESIDENT & CEO
Credential: M.D.
Phone: 859-957-0700