# WELLINGTON PROVIDER GROUP PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WELLINGTON PROVIDER GROUP PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1457012205
- **Legal business name:** WELLINGTON PROVIDER GROUP PC
- **Authorized official:** BRITTANY DENNIS (BILLING/CREDENTIALING MANAGER)
- **Authorized official phone:** (859) 518-8817

## Contact information

- **Practice address:** 535 WELLINGTON WAY STE 330, LEXINGTON, KY 40503-1331
- **Practice address phone:** (859) 439-0399
- **Mailing address:** 535 WELLINGTON WAY STE 330, LEXINGTON, KY 40503-1331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |
| 261QG0250X | Genetics Clinic/Center | — | NULL | — |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 01/04/2022
- **Last updated:** 05/18/2023