Healthcare Provider Details

I. General information

NPI: 1386190171
Provider Name (Legal Business Name): ELISABETH A PELT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 NORTH EAGLE CREEK STE 200
LEXINGTON KY
40509-1800
US

IV. Provider business mailing address

140 NORTH EAGLE CREEK STE 200
LEXINGTON KY
40509-1800
US

V. Phone/Fax

Practice location:
  • Phone: 859-338-8268
  • Fax: 859-263-8073
Mailing address:
  • Phone: 859-338-8268
  • Fax: 859-263-8073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number3009857
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: