Healthcare Provider Details

I. General information

NPI: 1629951025
Provider Name (Legal Business Name): BEWLEY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 OLIVER STATION CT STE 2
LOUISVILLE KY
40245-2101
US

IV. Provider business mailing address

13500 OLIVER STATION CT STE 2
LOUISVILLE KY
40245-2101
US

V. Phone/Fax

Practice location:
  • Phone: 502-244-4474
  • Fax: 502-271-5490
Mailing address:
  • Phone: 502-244-4474
  • Fax: 502-271-5490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMY JECKER
Title or Position: OFFICE MANAGER
Credential:
Phone: 502-244-4474