Healthcare Provider Details

I. General information

NPI: 1457751174
Provider Name (Legal Business Name): KENTUCKY ONE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 BEAUMONT CIRCLE SAINT JOSEPH HEALTHY LIFESTYLE CENTER
LEXINGTON KY
40513
US

IV. Provider business mailing address

1 SAINT JOSEPH DR
LEXINGTON KY
40504-3742
US

V. Phone/Fax

Practice location:
  • Phone: 859-219-0530
  • Fax: 859-219-0721
Mailing address:
  • Phone: 859-313-1000
  • Fax: 859-219-0721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number0948
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0948
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0948
License Number StateKY

VIII. Authorized Official

Name: MRS. NANCY K. DURALL
Title or Position: REGISTERED/LICENSED DIETITIAN
Credential: R.D., L.D.
Phone: 859-219-0530