Healthcare Provider Details

I. General information

NPI: 1629558291
Provider Name (Legal Business Name): DERMCARE PRACTITIONERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1169 EASTERN PKWY STE 431
LOUISVILLE KY
40217-1435
US

IV. Provider business mailing address

1169 EASTERN PKWY STE 431
LOUISVILLE KY
40217-1435
US

V. Phone/Fax

Practice location:
  • Phone: 502-361-3909
  • Fax: 502-361-9229
Mailing address:
  • Phone: 502-361-3909
  • Fax: 502-361-9229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTY QUIRE BAKER
Title or Position: OWNER
Credential: APRN
Phone: 502-361-3909