# KENTUCKY BLUE MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063862506
- **Authorized official:** CRANSTON SHEPPARD (OWNER)
- **Authorized official phone:** (502) 361-1159

## Contact information

- **Practice address:** 4602 SOUTHERN PKWY STE 1A, LOUISVILLE, KY 40214-1442
- **Practice address phone:** (502) 361-1159
- **Mailing address:** 4602 SOUTHERN PKWY STE 1A, LOUISVILLE, KY 40214-1442

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | — | NULL | Yes |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/15/2016
- **Last updated:** 06/15/2016