Healthcare Provider Details

I. General information

NPI: 1962176347
Provider Name (Legal Business Name): KENTUCKY ORTHOPAEDICS & SPINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LINVILLE DR STE 102
PARIS KY
40361-2165
US

IV. Provider business mailing address

404 SHOPPERS DR
WINCHESTER KY
40391-1301
US

V. Phone/Fax

Practice location:
  • Phone: 502-570-3754
  • Fax: 502-570-3756
Mailing address:
  • Phone: 859-737-5333
  • Fax: 859-737-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JOY CLEVENGER
Title or Position: CREDENTIALING AGENT
Credential:
Phone: 502-523-6695