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General NPI Number Information
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NPI Number | 1811195522
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Entity Type | Organization
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Legal Business Name | KENTUCKIANA PERINATOLOGY, PSC
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 07/31/2015
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Provider Practice Location Address
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Address Line | 210 E GRAY ST SUITE 803
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City | LOUISVILLE
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State | KY
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Zip | 40202-3902
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Country | US
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Telephone | 502-582-6900
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Fax | 502-582-5400
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Provider Business Mailing Address
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Address Line | 210 E GRAY ST SUITE 803
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City | LOUISVILLE
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State | KY
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Zip | 40202-3902
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Country | US
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Telephone | 502-582-6900
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Fax | 502-582-5400
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Authorized Official
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Title or Position | BILLING/CODING
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Name | SANDRA KAYE HAWORTH
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Credential | CRT, CPC, CPC-H,CIMC
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Telephone | 502-582-5999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 29075
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3003321
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3005620
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1101722
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License Number State | KY
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Taxonomy #5
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 29075
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License Number State | KY
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