Healthcare Provider Details

I. General information

NPI: 1912199365
Provider Name (Legal Business Name): BAPTIST FAMILY MEDICINE AT TATES CREEK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4071 TATES CREEK CENTRE DRIVE SUITE 100
LEXINGTON KY
40517
US

IV. Provider business mailing address

4071 TATES CREEK CENTRE DRIVE SUITE 100
LEXINGTON KY
40517
US

V. Phone/Fax

Practice location:
  • Phone: 859-273-3888
  • Fax: 859-272-3256
Mailing address:
  • Phone: 859-273-3888
  • Fax: 859-272-3256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GAIL FLECKINSTEIN
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 859-971-4633