Provider Demographics
NPI:1902297625
Name:WOMEN'S HEALTH CENTER OF CENTRAL KENTUCKY, PLLC
Entity Type:Organization
Organization Name:WOMEN'S HEALTH CENTER OF CENTRAL KENTUCKY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-469-4496
Mailing Address - Street 1:1858 OLD LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-9663
Mailing Address - Country:US
Mailing Address - Phone:270-469-4496
Mailing Address - Fax:270-469-0095
Practice Address - Street 1:1858 OLD LEBANON RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-9663
Practice Address - Country:US
Practice Address - Phone:270-469-4496
Practice Address - Fax:270-469-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006407363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1255655155OtherINDIVIDUAL NPI
KYK039550OtherMEDICARE PTAN
KY7100190090Medicaid