Healthcare Provider Details

I. General information

NPI: 1366539512
Provider Name (Legal Business Name): NORTHERN KENTUCKY FOOT SPECIALISTS, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 02/12/2010
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: 859-441-4334
  • Fax: 859-441-3698
Mailing address:
  • Phone: 859-746-7461
  • Fax: 859-746-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

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