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Organization
COMMONWEALTH SPECIALISTS OF KENTUCKY LLC
Active
Organization
COMMONWEALTH SPECIALISTS OF KENTUCKY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TEDRICK JOHNSON (VICE PRESIDENT)
(502) 352-2530
Entity
Organization
Contact information
Practice address
279 KINGS DAUGHTERS DR, SUITE 308, FRANKFORT, KY 40601-6514
(502) 352-2530
Mailing address
279 KINGS DAUGHTERS DR, SUITE 100, FRANKFORT, KY 40601-6514
(502) 352-2530
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
—
NULL
163WG0000X
General Practice Registered Nurse
—
—
207RC0000X
Cardiovascular Disease Physician
19
KY
207RG0100X
Gastroenterology Physician
19
KY
208600000X
Surgery Physician
19
KY
208VP0000X
Pain Medicine Physician
Primary
—
NULL
208VP0000X
Pain Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
19
KY
363L00000X
Nurse Practitioner
34
KY
Other
Enumeration date
05/29/2008
Last updated
02/06/2015
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