Healthcare Provider Details

I. General information

NPI: 1639493752
Provider Name (Legal Business Name): COLLINS LANE ELEMENTARY SCHOOL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COUGAR LN
FRANKFORT KY
40601-4300
US

IV. Provider business mailing address

100 GLENNS CREEK RD
FRANKFORT KY
40601-2473
US

V. Phone/Fax

Practice location:
  • Phone: 502-875-8410
  • Fax: 502-564-9640
Mailing address:
  • Phone: 502-564-4269
  • Fax: 502-564-9586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. PAULA ALEXANDER
Title or Position: PUBLIC HEALTH DIRECTOR
Credential: RN, BSN, MSN
Phone: 502-564-4269