Healthcare Provider Details

I. General information

NPI: 1497913552
Provider Name (Legal Business Name): CENTRAL KENTUCKY PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 S 4TH ST STE D
DANVILLE KY
40422-2078
US

IV. Provider business mailing address

PO BOX 31
DANVILLE KY
40423-0031
US

V. Phone/Fax

Practice location:
  • Phone: 859-238-0018
  • Fax: 859-238-0019
Mailing address:
  • Phone: 859-238-0018
  • Fax: 859-238-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number30318
License Number StateKY

VIII. Authorized Official

Name: PIOTR ZIEBA
Title or Position: PRESIDENT
Credential: MD
Phone: 859-238-0018