Organization
CENTRAL KENTUCKY DERMATOLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD CLARK MD (MEDICAL DIRECTOR)
(859) 608-9917
Entity
Organization
Contact information
Practice address
249 E BRANNON RD, NICHOLASVILLE, KY 40356-8059
(859) 354-5455
(859) 203-8833
Mailing address
249 E BRANNON RD, NICHOLASVILLE, KY 40356-8059
(859) 354-5455
(859) 203-8833
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Enumeration date
09/20/2022
Last updated
07/10/2025
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