Provider Demographics
NPI:1760583165
Name:KENTUCKY CARDIOLOGY, PLLC
Entity Type:Organization
Organization Name:KENTUCKY CARDIOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-226-0031
Mailing Address - Street 1:161 N EAGLE CREEK DR
Mailing Address - Street 2:STE 400
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-9038
Mailing Address - Country:US
Mailing Address - Phone:859-226-0031
Mailing Address - Fax:859-226-0041
Practice Address - Street 1:161 N EAGLE CREEK DR
Practice Address - Street 2:STE 400
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-9038
Practice Address - Country:US
Practice Address - Phone:859-226-0031
Practice Address - Fax:859-226-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65939985Medicaid
KY7836Medicare ID - Type Unspecified