Healthcare Provider Details

I. General information

NPI: 1194949552
Provider Name (Legal Business Name): HEATHER GENSEL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER DUNFEE

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 KINGS DAUGHTERS DR
FRANKFORT KY
40601-6514
US

IV. Provider business mailing address

425 LEWIS HARGETT CIR
LEXINGTON KY
40503-3590
US

V. Phone/Fax

Practice location:
  • Phone: 502-875-5240
  • Fax:
Mailing address:
  • Phone: 859-268-1030
  • Fax: 859-269-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number58.001869
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number03459
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: