# COMMONWEALTH SPECIALISTS OF KENTUCKY LLC

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

## Provider details

- **NPI number:** 1770741498
- **Authorized official:** MR. TEDRICK JOHNSON (VICE PRESIDENT)
- **Authorized official phone:** (502) 352-2530

## Contact information

- **Practice address:** 279 KINGS DAUGHTERS DR, SUITE 308, FRANKFORT, KY 40601-6514
- **Practice address phone:** (502) 352-2530
- **Mailing address:** 279 KINGS DAUGHTERS DR, SUITE 100, FRANKFORT, KY 40601-6514
- **Mailing address phone:** (502) 352-2530

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 208VP0000X | Pain Medicine Physician | — | — | Yes |
| 363A00000X | Physician Assistant | 19 | KY | — |
| 363L00000X | Nurse Practitioner | 34 | KY | — |

## Other

- **Enumeration date:** 05/29/2008
- **Last updated:** 02/06/2015