Healthcare Provider Details

I. General information

NPI: 1972517399
Provider Name (Legal Business Name): KIMBERLY RENEE FOUSHEE D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9127 FERN CREEK RD
LOUISVILLE KY
40291-2711
US

IV. Provider business mailing address

9127 FERN CREEK RD
LOUISVILLE KY
40291-2711
US

V. Phone/Fax

Practice location:
  • Phone: 502-239-0013
  • Fax: 502-239-0984
Mailing address:
  • Phone: 502-239-0013
  • Fax: 502-239-0984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6443
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: