Healthcare Provider Details

I. General information

NPI: 1023998572
Provider Name (Legal Business Name): MR. KEITH DEROME BARBOUR SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 PREAKNESS DR 341 PREAKNESS DR
LEXINGTON KY
40516-9667
US

IV. Provider business mailing address

341 PREAKNESS DR 341 PREAKNESS DR
LEXINGTON KY
40516-9667
US

V. Phone/Fax

Practice location:
  • Phone: 859-551-6615
  • Fax:
Mailing address:
  • Phone: 859-551-6615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: