Provider Demographics
NPI:1912005117
Name:NEPHROLOGY ASSOCIATES OF LEXINGTON PSC
Entity Type:Organization
Organization Name:NEPHROLOGY ASSOCIATES OF LEXINGTON PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CREELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-406-6170
Mailing Address - Street 1:1401 HARRODSBURG RD
Mailing Address - Street 2:C-335
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3751
Mailing Address - Country:US
Mailing Address - Phone:859-278-2575
Mailing Address - Fax:859-275-1630
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:C-335
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-278-2575
Practice Address - Fax:859-275-1630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - 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
KY6590578800Medicaid
KYCF7872Medicare PIN
KY6590578800Medicaid
KY9246Medicare PIN
KY0409Medicare PIN