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General NPI Number Information
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NPI Number | 1629558291
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Entity Type | Organization
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Legal Business Name | DERMCARE PRACTITIONERS, LLC
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Dates
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Enumeration Date | 08/14/2018
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Last Update Date | 02/21/2020
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Provider Practice Location Address
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Address Line | 1169 EASTERN PKWY STE 431
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City | LOUISVILLE
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State | KY
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Zip | 40217-1435
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Country | US
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Telephone | 502-361-3909
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Fax | 502-361-9229
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Provider Business Mailing Address
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Address Line | 1169 EASTERN PKWY STE 431
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City | LOUISVILLE
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State | KY
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Zip | 40217-1435
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Country | US
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Telephone | 502-361-3909
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Fax | 502-361-9229
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CHRISTY QUIRE BAKER
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Credential | APRN
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Telephone | 502-361-3909
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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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