Healthcare Provider Details

I. General information

NPI: 1730353590
Provider Name (Legal Business Name): ALETIA GAYLE FARMER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

J509 KENTUCKY CLINIC 740 S. LIMESTONE
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

B218 KENTUCKY CLINIC 740 S. LIMESTONE ST.
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-3900
  • Fax: 859-257-8138
Mailing address:
  • Phone: 859-323-3900
  • Fax: 859-257-8138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number41885
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: