# ANDOVER FAMILY MEDICINE

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

## Provider details

- **NPI number:** 1801951462
- **Authorized official:** DR. KIRSTEN LEA COOPER M.D. (PHYSICIAN)
- **Authorized official phone:** (859) 268-0254

## Contact information

- **Practice address:** 2801 PALUMBO DR, SUITE 200, LEXINGTON, KY 40509-1317
- **Practice address phone:** (859) 268-0254
- **Practice address fax:** (859) 263-0159
- **Mailing address:** PO BOX 55168, LEXINGTON, KY 40555-5168
- **Mailing address phone:** (859) 268-0254
- **Mailing address fax:** (859) 263-0159

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 33166 | KY | Yes |

## Other

- **Enumeration date:** 12/26/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000371547 | ANTHEM BCBS | KY |
| 01 | — | 1224232 | CHA | KY |
| 01 | — | 2075768 | FIRST HEALTH | KY |
| 01 | — | 5276688 | AETNA | KY |
| 05 | — | 65944324 | — | KY |
| 01 | — | 84146 | WASAU | KY |