Healthcare Provider Details

I. General information

NPI: 1558954776
Provider Name (Legal Business Name): KENTUCKY HOSPITALIST GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 03/06/2021
Certification Date: 03/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3117 AYLESBURY CIR
LEXINGTON KY
40509-2372
US

IV. Provider business mailing address

3117 AYLESBURY CIR
LEXINGTON KY
40509-2372
US

V. Phone/Fax

Practice location:
  • Phone: 859-948-8430
  • Fax: 859-744-3095
Mailing address:
  • Phone: 859-948-8430
  • Fax: 859-744-3095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DEBI CAREY
Title or Position: CREDENTIALING AGENT
Credential:
Phone: 859-576-9895