Healthcare Provider Details

I. General information

NPI: 1336209865
Provider Name (Legal Business Name): PEDIATRIC PARTNERS OF NORTHERN KENTUCKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 HIGHLAND PIKE SUITE 1
FT WRIGHT KY
41017-8127
US

IV. Provider business mailing address

1945 HIGHLAND PIKE SUITE 1
FT WRIGHT KY
41017-8127
US

V. Phone/Fax

Practice location:
  • Phone: 859-331-4005
  • Fax:
Mailing address:
  • Phone: 859-331-4005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA SPRAGUE
Title or Position: OFFICE MANAGER
Credential:
Phone: 859-331-4005