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General NPI Number Information
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NPI Number | 1164795233
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Entity Type | Organization
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Legal Business Name | BAPTIST FAMILY MEDICINE AT TATES CREEK
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Dates
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Enumeration Date | 02/20/2012
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Last Update Date | 04/22/2013
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Provider Practice Location Address
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Address Line | 4071 TATES CREEK CENTRE DRIVE SUITE 202
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City | LEXINGTON
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State | KY
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Zip | 40517
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Country | US
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Telephone | 859-273-3888
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Fax | 859-971-4601
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Provider Business Mailing Address
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Address Line | 4071 TATES CREEK CENTRE DRIVE SUITE 202
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City | LEXINGTON
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State | KY
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Zip | 40517
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Country | US
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Telephone | 859-273-3888
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Fax | 859-971-4601
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Authorized Official
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Title or Position | REVENUE CYCLE DIRECTOR
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Name | GAIL FLECKINSTEIN
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Credential |
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Telephone | 859-971-4633
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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 | 3002500
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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