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General NPI Number Information
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NPI Number | 1154034395
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Entity Type | Organization
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Legal Business Name | HEYDAY HEALTH MEDICAL GROUP KENTUCKY, PSC
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Dates
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Enumeration Date | 01/03/2023
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 312 S 4TH ST STE 700
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City | LOUISVILLE
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State | KY
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Zip | 40202-3046
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Country | US
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Telephone | 855-443-9329
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Fax |
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Provider Business Mailing Address
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Address Line | 143 BOARDMAN CANFIELD RD STE 359
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City | BOARDMAN
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State | OH
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Zip | 44512-4804
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NUPUR MEHTA
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Credential |
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Telephone | 234-200-0854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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