Organization
NORTON CHILDREN'S MEDICAL GROUP, LLC
Active
Other names
Norton Children's Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHELLEY GAST (SYST VP MNGD CARE & PAYOR STRAT)
(502) 272-5335
Entity
Organization
Contact information
Practice address
4803 OLYMPIA PARK PLZ STE 1100, LOUISVILLE, KY 40241-3068
(502) 272-5134
(502) 272-5339
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 272-5134
(502) 272-5339
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207NP0225X
Pediatric Dermatology Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Enumeration date
02/10/2020
Last updated
09/22/2021
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