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1162 Lexington Rd Georgetown KY 40324-9330 | |
| (502) 863-6426 | |
| (502) 868-9724 |
| Full Name | |
|---|---|
| Speciality | Nurse Practitioner - Pediatrics |
| Location | 1162 Lexington Rd, Georgetown, Kentucky |
| Authorized Official Name and Position | Johanne Goodykoontz (OFFICE MANAGER) |
| Authorized Official Contact | 5028636426 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1162 Lexington Rd Georgetown KY 40324-9330 Ph: (502) 863-6426 | 1162 Lexington Rd Georgetown KY 40324-9330 Ph: (502) 863-6426 |
| NPI Number | 1275179020 |
|---|---|
| Provider Enumeration Date | 11/26/2019 |
| Last Update Date | 04/12/2023 |
| Certification Date | 04/12/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275179020 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 363LP0200X | Nurse Practitioner - Pediatrics | (* (Not Available)) | Primary |
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