Healthcare Provider Details

I. General information

NPI: 1023207735
Provider Name (Legal Business Name): WOMEN'S HEALTH OF WINCHESTER PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 HOSPITAL DR BLDG B, STE 255
WINCHESTER KY
40391-7676
US

IV. Provider business mailing address

225 HOSPITAL DR BLDG B, STE 255
WINCHESTER KY
40391-7676
US

V. Phone/Fax

Practice location:
  • Phone: 859-744-2623
  • Fax: 859-744-9421
Mailing address:
  • Phone: 859-744-2623
  • Fax: 859-744-9421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number1051070
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: JOY CLEVENGER
Title or Position: CREDENTIALING
Credential:
Phone: 502-523-6695