Healthcare Provider Details

I. General information

NPI: 1386557601
Provider Name (Legal Business Name): DERMATOLOGY DIRECT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 N GRAND AVE STE 8
FORT THOMAS KY
41075-1755
US

IV. Provider business mailing address

20 N GRAND AVE STE 8
FORT THOMAS KY
41075-1755
US

V. Phone/Fax

Practice location:
  • Phone: 859-712-3007
  • Fax: 859-712-3007
Mailing address:
  • Phone: 859-712-3007
  • Fax: 859-712-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JENNIFER MARTIN
Title or Position: OWNER/DERMATOLOGIST
Credential: MD, FAAD
Phone: 615-500-3151