MEDICARE: KENTUCKIANA PSYCHOLOGICAL ASSOCIATES PLLC

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	103TC2200X	Clinical Child & Adolescent Psychologist
2	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1669327151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENTUCKIANA PSYCHOLOGICAL ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	9400 WILLIAMSBURG PLZ STE 310
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-6016
Country	:	US
Telephone Number	:	502-627-0303
Fax Number	:

Provider Business Practice Location Address
First Line	:	9400 WILLIAMSBURG PLZ STE 310
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-6016
Country	:	US
Telephone Number	:	502-627-0303
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	BYRON A WHITE
Credential	:	PSY.D.
Telephone Number	:	502-627-0303

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/19/2026

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