Healthcare Provider Details

I. General information

NPI: 1164829784
Provider Name (Legal Business Name): KENTUCKY CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S LIMESTONE
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

320 LINDENHURST DR APT 13107
LEXINGTON KY
40509-1346
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-0101
  • Fax:
Mailing address:
  • Phone: 618-841-6282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberTC337
License Number StateKY

VIII. Authorized Official

Name: TRIA KINNARD
Title or Position: NEONATOLOGY PROVIDER
Credential: PA-C
Phone: 859-323-0101