Provider Demographics
NPI:1376949396
Name:BLUEGRASS FAMILY ALLERGY, PLLC
Entity Type:Organization
Organization Name:BLUEGRASS FAMILY ALLERGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:BRAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-929-7977
Mailing Address - Street 1:PO BOX 22230
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-2230
Mailing Address - Country:US
Mailing Address - Phone:270-282-2477
Mailing Address - Fax:270-282-2476
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:BUILDING A
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-282-2477
Practice Address - Fax:270-282-2476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2015-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41114207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty