Provider Demographics
NPI:1356313423
Name:VINCENT, KATHY MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:MARIE
Last Name:VINCENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E CHESTNUT ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-5700
Mailing Address - Country:US
Mailing Address - Phone:502-588-4450
Mailing Address - Fax:502-588-4427
Practice Address - Street 1:401 E CHESTNUT ST
Practice Address - Street 2:SUITE 610
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5700
Practice Address - Country:US
Practice Address - Phone:502-588-4450
Practice Address - Fax:502-588-9539
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY321662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64321664Medicaid
KY396165OtherTRICARE
IN200821240Medicaid
0026960OtherPTAN
KY64321664Medicaid
IN200821240Medicaid
KYP00101896Medicare PIN
KY0060299Medicare PIN