Healthcare Provider Details

I. General information

NPI: 1952292658
Provider Name (Legal Business Name): IESHIA CHACHAREL DENISE FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 BURT RD STE 19
LEXINGTON KY
40503-2401
US

IV. Provider business mailing address

748 SPRUCEWOOD DR
LEXINGTON KY
40514-1191
US

V. Phone/Fax

Practice location:
  • Phone: 859-270-6971
  • Fax:
Mailing address:
  • Phone: 859-270-6971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: