MEDICARE: MISTY ADAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency		KY
2	222Q00000X	Developmental Therapist		KY

General Provider Information

NPI Number	:	1538554233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISTY ADAMS

Provider Business Mailing Address
First Line	:	3308 OTTER CREEK DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40515-5931
Country	:	US
Telephone Number	:	859-684-2662
Fax Number	:

Provider Business Practice Location Address
First Line	:	3308 OTTER CREEK DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40515-5931
Country	:	US
Telephone Number	:	859-684-2662
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2015
Last Update Date	:	03/12/2026

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Directions to “ MISTY ADAMS ” Practice Location

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