# NORTON CHILDREN'S MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Norton Children's Genetics Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770190167
- **Authorized official:** SHELLEY GAST (SYST VP MNGD CARE & PAYOR STRAT)
- **Authorized official phone:** (502) 272-5335

## Contact information

- **Practice address:** 4803 OLYMPIA PARK PLZ STE 1100, LOUISVILLE, KY 40241-3068
- **Practice address phone:** (502) 272-5336
- **Practice address fax:** (502) 272-5339
- **Mailing address:** PO BOX 776879, CHICAGO, IL 60677-6879
- **Mailing address phone:** (502) 272-5336
- **Mailing address fax:** (502) 272-5339

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC0700X | Clinical Psychologist | — | NULL | — |
| 103TC0700X | Clinical Psychologist | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 133V00000X | Registered Dietitian | — | NULL | — |
| 133V00000X | Registered Dietitian | — | — | — |
| 133VN1006X | Metabolic Nutrition Registered Dietitian | — | NULL | — |
| 133VN1006X | Metabolic Nutrition Registered Dietitian | — | — | — |
| 170300000X | Genetic Counselor (M.S.) | — | NULL | — |
| 170300000X | Genetic Counselor (M.S.) | — | — | — |
| 207SG0201X | Clinical Genetics (M.D.) Physician | — | NULL | Yes |
| 207SG0201X | Clinical Genetics (M.D.) Physician | — | — | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0200X | Pediatric Nurse Practitioner | — | NULL | — |
| 363LP0200X | Pediatric Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 09/29/2020
- **Last updated:** 01/10/2022