Healthcare Provider Details

I. General information

NPI: 1467688770
Provider Name (Legal Business Name): WOUND PROFESSIONAL SERVICES OF KENTUCKY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13317 WESTBURY WAY
GOSHEN KY
40026-8422
US

IV. Provider business mailing address

13317 WESTBURY WAY
GOSHEN KY
40026-8422
US

V. Phone/Fax

Practice location:
  • Phone: 502-409-8223
  • Fax: 502-409-8330
Mailing address:
  • Phone: 502-409-8223
  • Fax: 502-409-8330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TERRY L MUELLER
Title or Position: SR VP OF NURSING SERVICES
Credential: RN
Phone: 502-409-8223