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General NPI Number Information
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NPI Number | 1013784982
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Entity Type | Organization
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Legal Business Name | MT WASHINGTON PEDIATRICS PLLC
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 138 EASTBROOKE CT UNIT 115
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City | MOUNT WASHINGTON
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State | KY
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Zip | 40047-5570
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Country | US
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Telephone | 502-617-4068
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Fax |
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Provider Business Mailing Address
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Address Line | 138 EASTBROOKE CT UNIT 115
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City | MOUNT WASHINGTON
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State | KY
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Zip | 40047-5570
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Country | US
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Telephone | 502-617-4068
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALICIA ANDERSON
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Credential | APRN
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Telephone | 502-617-4068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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