Healthcare Provider Details

I. General information

NPI: 1225114044
Provider Name (Legal Business Name): NORTHERN KENTUCKY FOOT SPECIALISTS, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 ALEXANDRIA PIKE SUITE 230
SOUTHGATE KY
41071-3290
US

IV. Provider business mailing address

PO BOX 389
BURLINGTON KY
41005-0389
US

V. Phone/Fax

Practice location:
  • Phone: 859-781-8890
  • Fax: 859-781-1120
Mailing address:
  • Phone: 859-746-7461
  • Fax: 859-746-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM M NIELSON
Title or Position: PRESIDENT
Credential: DPM
Phone: 859-746-7461