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General NPI Number Information
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NPI Number | 1245191915
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Entity Type | Organization
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Legal Business Name | VITALE DERMATOLOGY PLLC
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Dates
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Enumeration Date | 11/20/2025
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 505 SHOPPERS DR STE 1
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City | WINCHESTER
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State | KY
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Zip | 40391-2808
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Country | US
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Telephone | 606-359-1562
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Fax |
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Provider Business Mailing Address
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Address Line | 1795 ALYSHEBA WAY STE 4101
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City | LEXINGTON
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State | KY
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Zip | 40509-2488
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Country | US
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Telephone | 606-359-1562
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Fax | 606-671-3681
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY SMALLWOOD
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Credential | DNP, APRN, FNP-BC
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Telephone | 606-359-1562
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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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