Healthcare Provider Details

I. General information

NPI: 1639199904
Provider Name (Legal Business Name): LEXINGTON OB GYN ASSOCIATES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 NICHOLASVILLE RD STE 701
LEXINGTON KY
40503-1467
US

IV. Provider business mailing address

1700 NICHOLASVILLE RD STE 701
LEXINGTON KY
40503-1467
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-0396
  • Fax: 859-277-5414
Mailing address:
  • Phone: 859-278-0396
  • Fax: 859-277-5414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number7100514990
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number65904625
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number7100514990
License Number StateKY

VIII. Authorized Official

Name: MRS. ELIZABETH L OWEN
Title or Position: PRACTICE MANAGER
Credential: RN
Phone: 859-278-0396