Healthcare Provider Details

I. General information

NPI: 1407882913
Provider Name (Legal Business Name): CLARISSA SHORT BEITING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N EAGLE CREEK DR STE 400
LEXINGTON KY
40509-2124
US

IV. Provider business mailing address

1221 S BROADWAY
LEXINGTON KY
40504-2701
US

V. Phone/Fax

Practice location:
  • Phone: 859-258-5220
  • Fax: 859-276-5405
Mailing address:
  • Phone: 859-258-6360
  • Fax: 859-276-6392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35970
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: