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General NPI Number Information
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NPI Number | 1457797219
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Entity Type | Organization
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Legal Business Name | OPTIMAL HEALTH PRIMARY CARE CENTER PLLC
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 8333 ALEXANDRIA PIKE
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City | ALEXANDRIA
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State | KY
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Zip | 41001-1187
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Country | US
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Telephone | 859-635-0867
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Fax |
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Provider Business Mailing Address
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Address Line | 8333 ALEXANDRIA PIKE
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City | ALEXANDRIA
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State | KY
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Zip | 41001-1187
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Country | US
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Telephone | 859-635-0867
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NANCY HUDSON
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Credential | APRN
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Telephone | 859-635-0867
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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 | 3006443
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License Number State | KY
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