Healthcare Provider Details

I. General information

NPI: 1275364002
Provider Name (Legal Business Name): SYNERGY PSYCHIATRY AND WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 CHAMPION WAY STE 7
GEORGETOWN KY
40324-8861
US

IV. Provider business mailing address

203 CHAMPION WAY STE 7
GEORGETOWN KY
40324-8861
US

V. Phone/Fax

Practice location:
  • Phone: 270-225-4033
  • Fax:
Mailing address:
  • Phone: 270-225-4033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAIME VARNEY
Title or Position: CEO
Credential: PMHNP-BC
Phone: 270-225-4033