Healthcare Provider Details

I. General information

NPI: 1063123735
Provider Name (Legal Business Name): KENTUCKY URGENT CARE WALK-IN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 PASADENA DR STE 110
LEXINGTON KY
40503-3061
US

IV. Provider business mailing address

14671 TELEGRAPH RD
REDFORD MI
48239-3300
US

V. Phone/Fax

Practice location:
  • Phone: 313-948-3055
  • Fax:
Mailing address:
  • Phone: 313-948-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
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: NANCY MOLNAR
Title or Position: BUSINESS OPERATIONS MANAGER
Credential:
Phone: 313-948-3055