# HEART SPECIALISTS OF SE KY PSC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** HEART SPECIALISTS OF SE KY PSC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386752756
- **Authorized official:** JANIE RENEE OKUMA (OFFICE MANAGER)
- **Authorized official phone:** (606) 523-9010

## Contact information

- **Practice address:** 45 MOONBOW PLZ, CORBIN, KY 40701-8949
- **Practice address phone:** (606) 523-9010
- **Practice address fax:** (606) 523-5923
- **Mailing address:** 45 MOONBOW PLZ, CORBIN, KY 40701-8949
- **Mailing address phone:** (606) 523-9010
- **Mailing address fax:** (606) 523-5923

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | 29557 | KY | Yes |
| 363A00000X | Physician Assistant | PA249 | KY | — |
| 363L00000X | Nurse Practitioner | 4069P | KY | — |

## Other

- **Enumeration date:** 08/27/2006
- **Last updated:** 06/30/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 65914996 | — | KY |