Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 104100000X | Social Worker | | KY-1480 | KENTUCKY | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 000000495964 | OTHER | KENTUCKY | ANTHEM |
| 2 | 0359099 | MEDICARE ID-TYPE UNSPECIFIED | KENTUCKY | GRP 3590 |
| 3 | 0359297 | MEDICARE ID-TYPE UNSPECIFIED | KENTUCKY | GRP 3592 |
| 4 | 30605018 | MEDICAID | KENTUCKY | |
| 5 | 0358697 | MEDICARE ID-TYPE UNSPECIFIED | KENTUCKY | GRP 3586 |
| 6 | 0762242 | MEDICARE ID-TYPE UNSPECIFIED | KENTUCKY | GRP 7622 |
| 7 | 0763540 | MEDICARE ID-TYPE UNSPECIFIED | KENTUCKY | GRP 7635 |
| 8 | 0974713 | MEDICARE ID-TYPE UNSPECIFIED | KENTUCKY | GRP 9747 |
| 9 | 0690945 | MEDICARE ID-TYPE UNSPECIFIED | KENTUCKY | GRP 0266 |
| 10 | 0762340 | MEDICARE ID-TYPE UNSPECIFIED | KENTUCKY | GRP 7623 |
| 11 | 0358797 | MEDICARE ID-TYPE UNSPECIFIED | KENTUCKY | GRP 3587 |
| 12 | 0358898 | MEDICARE ID-TYPE UNSPECIFIED | KENTUCKY | GRP 3588 |
| 13 | 0358999 | MEDICARE ID-TYPE UNSPECIFIED | KENTUCKY | GRP 3589 |