Healthcare Provider Details

I. General information

NPI: 1437108099
Provider Name (Legal Business Name): NORTHERN KENTUCKY PSYCHIATRY ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 GRANDVIEW DR
FT MITCHELL KY
41017-1633
US

IV. Provider business mailing address

2380 GRANDVIEW DR
FT MITCHELL KY
41017-1633
US

V. Phone/Fax

Practice location:
  • Phone: 859-331-7234
  • Fax: 859-578-7986
Mailing address:
  • Phone: 859-331-7234
  • Fax: 859-578-7986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AGUSTINA A. BALUYOT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 859-331-7234