Healthcare Provider Details

I. General information

NPI: 1376461517
Provider Name (Legal Business Name): MADISON HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 W MAIN ST STE 100
LEXINGTON KY
40508-2065
US

IV. Provider business mailing address

3526 RIVER PARK DR
LEXINGTON KY
40517-3503
US

V. Phone/Fax

Practice location:
  • Phone: 859-245-2400
  • Fax: 859-245-2443
Mailing address:
  • Phone: 859-550-9937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: