Healthcare Provider Details

I. General information

NPI: 1679334643
Provider Name (Legal Business Name): DIRECT PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6302 MEETING ST UNIT 101
PROSPECT KY
40059-8705
US

IV. Provider business mailing address

6302 MEETING ST
PROSPECT KY
40059-8705
US

V. Phone/Fax

Practice location:
  • Phone: 502-551-6601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA HONAKER
Title or Position: OWNER
Credential: MD
Phone: 502-551-6601