Provider Demographics
NPI:1740591601
Name:CENTRAL KY NEPHROLOGY & HYPERTENSION
Entity Type:Organization
Organization Name:CENTRAL KY NEPHROLOGY & HYPERTENSION
Other - Org Name:CENTRAL KY KIDNEY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:DELEAN
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-576-2831
Mailing Address - Street 1:1451 HARRODSBURG RD
Mailing Address - Street 2:SUITE D-304
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3758
Mailing Address - Country:US
Mailing Address - Phone:859-977-4000
Mailing Address - Fax:859-977-5100
Practice Address - Street 1:2101 NICHOLASVILLE RD STE 303
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2526
Practice Address - Country:US
Practice Address - Phone:859-373-1176
Practice Address - Fax:859-275-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207RN0300X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100031690Medicaid
KY7100031690Medicaid