Organization
VANDERBILT INTEGRATED PROVIDERS
Active
Parent organization
VANDERBILT INTEGRATED PROVIDERS D.B.A PEDIATRIC ASSOCIATES
Other names
Pediatric Associates
Organization subpart
Yes
Provider details
NPI number
Legal business name
VANDERBILT INTEGRATED PROVIDERS D.B.A PEDIATRIC ASSOCIATES
Authorized official
MR. CHRIS WESTBROOK (ASSISTANT DIRECTOR)
(615) 936-5187
Entity
Organization
Contact information
Practice address
1717 HIGH STREET, SUITE 3A, HOPKINSVILLE, KY 42240
(270) 885-8445
(270) 886-9106
Mailing address
1717 HIGH STREET, SUITE 3A, HOPKINSVILLE, KY 42240
(270) 885-8445
(270) 886-9106
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
3002428
KY
363LP0200X
Pediatric Nurse Practitioner
3004549
KY
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78900800
—
KY
Enumeration date
03/09/2007
Last updated
02/27/2013
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