=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225822372
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOURNEY HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2025
-----------------------------------------------------
Last Update Date | 04/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3094 HARRODSBURG RD STE 201
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40503-2897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-605-8060
-----------------------------------------------------
Fax | 859-605-8061
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3094 HARRODSBURG RD STE 201
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40503-2897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-605-8060
-----------------------------------------------------
Fax | 859-605-8061
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PHILLIP ANDREW WILLIFORD
-----------------------------------------------------
Credential | PA-C
-----------------------------------------------------
Telephone | 859-605-8060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------