Healthcare Provider Details

I. General information

NPI: 1497157341
Provider Name (Legal Business Name): APP OF KENTUCKY ED, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CENTER DR
PRINCETON KY
42445
US

IV. Provider business mailing address

5121 MARYLAND WAY STE 300
BRENTWOOD TN
37027-7516
US

V. Phone/Fax

Practice location:
  • Phone: 270-365-0300
  • Fax:
Mailing address:
  • Phone: 855-246-8607
  • Fax: 615-922-6723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES GRIMES
Title or Position: CFO
Credential:
Phone: 855-246-8607