Healthcare Provider Details

I. General information

NPI: 1346035524
Provider Name (Legal Business Name): ONLY YOU WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 KEENE CENTRE DR
NICHOLASVILLE KY
40356-1492
US

IV. Provider business mailing address

459 KEENE CENTRE DR
NICHOLASVILLE KY
40356-1492
US

V. Phone/Fax

Practice location:
  • Phone: 859-241-1136
  • Fax: 859-241-1009
Mailing address:
  • Phone: 859-241-1136
  • Fax: 859-241-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSANNA LEIGH MOBERLY
Title or Position: OWNER
Credential:
Phone: 859-241-1136