Healthcare Provider Details

I. General information

NPI: 1902036825
Provider Name (Legal Business Name): KENTUCKIANA GERIATRIC AND PALLIATIVE SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1877 FARNSLEY RD
LOUISVILLE KY
40216-4701
US

IV. Provider business mailing address

PO BOX 8133
LOUISVILLE KY
40257-8133
US

V. Phone/Fax

Practice location:
  • Phone: 502-544-8293
  • Fax:
Mailing address:
  • Phone: 502-544-8293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number StateKY
# 6
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MUHAMMAD BABAR
Title or Position: MEMBER
Credential: M.D.
Phone: 502-544-8293