# KENTUCKY DERMATOLOGY AND SKIN CANCER CLINIC, PSC

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

## Provider details

- **NPI number:** 1831310390
- **Authorized official:** KAYE FENSTERMAKER (PRACTICE MANAGER)
- **Authorized official phone:** (859) 276-1511

## Contact information

- **Practice address:** 177 BURT RD, LEXINGTON, KY 40503-2410
- **Practice address phone:** (859) 276-1511
- **Practice address fax:** (859) 276-3373
- **Mailing address:** 177 BURT RD, LEXINGTON, KY 40503-2410
- **Mailing address phone:** (859) 276-1511
- **Mailing address fax:** (859) 276-3373

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | — | NULL | Yes |
| 174400000X | Specialist | — | — | Yes |
| 207N00000X | Dermatology Physician | — | NULL | — |
| 207N00000X | Dermatology Physician | — | — | — |

## Other

- **Enumeration date:** 05/01/2007
- **Last updated:** 08/27/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | C16315 | RR MEDICARE | KY |