Organization
COMMONWEALTH FAMILY MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAY CHARLES KENNEDY MD (MEDICAL DIRECTOR)
(502) 377-8138
Entity
Organization
Contact information
Practice address
12400 SHELBYVILLE RD, LOUISVILLE, KY 40243-1419
(502) 883-2218
Mailing address
12400 SHELBYVILLE ROAD, LOUISVILLE, KY 40245-4313
(502) 883-2218
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/17/2013
Last updated
08/03/2017
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