Healthcare Provider Details

I. General information

NPI: 1942122155
Provider Name (Legal Business Name): VICKY GAY CLEMENTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SPRINGSIDE WAY
LOUISVILLE KY
40223-3782
US

IV. Provider business mailing address

3511 OUR ST
HENRYVILLE IN
47126-8887
US

V. Phone/Fax

Practice location:
  • Phone: 502-767-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: