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General NPI Number Information
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NPI Number | 1114660735
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Entity Type | Organization
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Legal Business Name | PATRIOT ONE PRIMARY CARE PSC
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Dates
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Enumeration Date | 04/20/2022
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 989 GOVERNORS LN STE 140
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City | LEXINGTON
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State | KY
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Zip | 40513-1174
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Country | US
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Telephone | 859-447-8014
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Fax |
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Provider Business Mailing Address
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Address Line | 989 GOVERNORS LN STE 220
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City | LEXINGTON
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State | KY
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Zip | 40513-1175
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Country | US
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Telephone | 859-447-8014
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | JANINE LIPPERT
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Credential | PCNP-PC
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Telephone | 859-433-4661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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