=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033358726
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEXINGTON PODIATRY PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2009
-----------------------------------------------------
Last Update Date | 07/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2700 OLD ROSEBUD RD STE 250
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40509-8625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-264-1141
-----------------------------------------------------
Fax | 859-264-1963
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2700 OLD ROSEBUD RD STE 250
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40509-8625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-264-1141
-----------------------------------------------------
Fax | 859-264-1963
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. NICOLE G FREELS
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 859-264-1141
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------