Provider Demographics
NPI:1437108099
Name:NORTHERN KENTUCKY PSYCHIATRY ASSOC
Entity Type:Organization
Organization Name:NORTHERN KENTUCKY PSYCHIATRY ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AGUSTINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BALUYOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-331-7234
Mailing Address - Street 1:2380 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1633
Mailing Address - Country:US
Mailing Address - Phone:859-331-7234
Mailing Address - Fax:859-578-7986
Practice Address - Street 1:2380 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:FT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-1633
Practice Address - Country:US
Practice Address - Phone:859-331-7234
Practice Address - Fax:859-578-7986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5796OtherANTHEM
KY079122000OtherMAGELLAN
KY65930505Medicaid
KY7100199660Medicaid
KY7100199660Medicaid