Healthcare Provider Details

I. General information

NPI: 1316072432
Provider Name (Legal Business Name): KENTUCKY URGENT TREATMENT ASSOCIATES, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 BELLAIRE DRIVE
NICHOLASVILLE KY
40356-8840
US

IV. Provider business mailing address

3174 CUSTER DR SUITE 100
LEXINGTON KY
40517-4000
US

V. Phone/Fax

Practice location:
  • Phone: 859-887-4882
  • Fax:
Mailing address:
  • Phone: 859-273-8882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LARRY C. BURNS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 859-273-8882