Healthcare Provider Details

I. General information

NPI: 1407775901
Provider Name (Legal Business Name): MOLLY SHOOT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S BROADWAY
LEXINGTON KY
40504-2771
US

IV. Provider business mailing address

1221 S BROADWAY
LEXINGTON KY
40504-2771
US

V. Phone/Fax

Practice location:
  • Phone: 859-258-4000
  • Fax:
Mailing address:
  • Phone: 859-258-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number4044033
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: