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General NPI Number Information
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NPI Number | 1255621371
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Entity Type | Organization
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Legal Business Name | LEXINGTON CHILD AND ADOLESCENT PSYCHIATRY
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 3270 BLAZER PKWY SUITE 101
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City | LEXINGTON
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State | KY
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Zip | 40509-2115
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Country | US
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Telephone | 859-264-1182
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Fax | 859-263-1187
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Provider Business Mailing Address
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Address Line | 3270 BLAZER PKWY SUITE 101
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City | LEXINGTON
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State | KY
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Zip | 40509-2115
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Country | US
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Telephone | 859-264-1182
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Fax | 859-263-1187
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Authorized Official
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Title or Position | OWNER
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Name | TAMELA G GILBERT
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Credential | MD
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Telephone | 859-264-1182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 28004
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License Number State | KY
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