Healthcare Provider Details

I. General information

NPI: 1669275160
Provider Name (Legal Business Name): WESTON ELLIS MCDONALD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE STREET MN 275
LEXINGTON KY
40536-0293
US

IV. Provider business mailing address

800 ROSE STREET MN 275
LEXINGTON KY
40536-0293
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6162
  • Fax: 859-257-8934
Mailing address:
  • Phone: 859-323-6162
  • Fax: 859-257-8934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: