Healthcare Provider Details

I. General information

NPI: 1992549836
Provider Name (Legal Business Name): IANA KIRICHUK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 FOUNTAIN CT
LEXINGTON KY
40509-2792
US

IV. Provider business mailing address

245 FOUNTAIN CT
LEXINGTON KY
40509-2792
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6861
  • Fax:
Mailing address:
  • Phone: 859-323-6021
  • Fax: 859-323-1670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR7079
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: