Healthcare Provider Details

I. General information

NPI: 1760583165
Provider Name (Legal Business Name): KENTUCKY CARDIOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 N EAGLE CREEK DR STE 400
LEXINGTON KY
40509-9038
US

IV. Provider business mailing address

161 N EAGLE CREEK DR STE 400
LEXINGTON KY
40509-9038
US

V. Phone/Fax

Practice location:
  • Phone: 859-226-0031
  • Fax: 859-226-0041
Mailing address:
  • Phone: 859-226-0031
  • Fax: 859-226-0041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY NOVAK
Title or Position: PRACTICE MANAGER
Credential:
Phone: 859-226-0031