Healthcare Provider Details

I. General information

NPI: 1386068112
Provider Name (Legal Business Name): PENNYRILE NEPHROLOGY ASSOCIATES, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2014
Last Update Date: 07/21/2022
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 WATERFALL CT
MADISONVILLE KY
42431-8079
US

IV. Provider business mailing address

1020 WATERFALL CT
MADISONVILLE KY
42431-8079
US

V. Phone/Fax

Practice location:
  • Phone: 270-821-5726
  • Fax: 270-326-2090
Mailing address:
  • Phone: 270-821-5726
  • Fax: 270-326-2090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: IMRAN DOSANI
Title or Position: PRESIDENT
Credential: MD
Phone: 270-821-5726