Healthcare Provider Details

I. General information

NPI: 1881056893
Provider Name (Legal Business Name): LAURA HENCH GOODSELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 12/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF KENTUCKY 800 ROSE STREET
LEXINGTON KY
40536-0293
US

IV. Provider business mailing address

900 S LIMESTONE CTW 304
LEXINGTON KY
40536-7001
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-1000
  • Fax: 859-323-1200
Mailing address:
  • Phone: 859-323-6642
  • Fax: 859-323-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR4090
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: