Organization
COMMONWEALTH OF KENTUCKY
Active
Parent organization
COMMONWEALTH OF KENTUCKY
Other names
EASTERN STATE HOSPITAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMONWEALTH OF KENTUCKY
Authorized official
JENNIFER MOORE (ASSISTANT DIRECTOR)
(502) 782-6117
Entity
Organization
Contact information
Practice address
1350 BULL LEA RD, LEXINGTON, KY 40511-1247
(859) 246-8000
(859) 246-8043
Mailing address
1350 BULL LEA RD, LEXINGTON, KY 40511-1247
(859) 246-8000
(859) 246-8043
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
KY
2084N0400X
Neurology Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208D00000X
General Practice Physician
—
—
363A00000X
Physician Assistant
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100105800
—
KY
Enumeration date
03/17/2008
Last updated
10/30/2024
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