Healthcare Provider Details

I. General information

NPI: 1497761894
Provider Name (Legal Business Name): KENTUCKY FERTILITY AND ANDROLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N EAGLE CREEK DR SUITE 203
LEXINGTON KY
40509-1832
US

IV. Provider business mailing address

PO BOX 24787
LEXINGTON KY
40524-4787
US

V. Phone/Fax

Practice location:
  • Phone: 859-277-5736
  • Fax: 859-276-2236
Mailing address:
  • Phone: 859-277-5736
  • Fax: 859-276-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number02485
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA779
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2995P
License Number StateKY

VIII. Authorized Official

Name: GEORGE MICHAEL VELOUDIS JR.
Title or Position: MEMBER/PHYSICIAN
Credential: D.O.
Phone: 859-277-5736