Healthcare Provider Details

I. General information

NPI: 1942790167
Provider Name (Legal Business Name): LAUREL COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 WHITLEY ST
LONDON KY
40741-2626
US

IV. Provider business mailing address

525 WHITLEY ST
LONDON KY
40741-2626
US

V. Phone/Fax

Practice location:
  • Phone: 606-864-5187
  • Fax: 606-864-8295
Mailing address:
  • Phone: 606-864-5187
  • Fax: 606-864-8295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: STEPHANIE MARTIN
Title or Position: ADMINISTRATIVE SPECIALIST
Credential:
Phone: 606-864-5244