Healthcare Provider Details

I. General information

NPI: 1659196111
Provider Name (Legal Business Name): DOMINI ALEXIS PLYMALE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 02/11/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 HUSTON DR STE 1
SHEPHERDSVILLE KY
40165-7250
US

IV. Provider business mailing address

319 N MULBERRY ST
ELIZABETHTOWN KY
42701-1845
US

V. Phone/Fax

Practice location:
  • Phone: 502-955-7311
  • Fax:
Mailing address:
  • Phone: 270-300-2501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4027964
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4027964
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: