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 | 363A00000X | Physician Assistant | | | KENTUCKY | No |
| 2 | 363AM0700X | Physician Assistant | Medical | | | No |
| 3 | 207Q00000X | Family Medicine | | | WEST VIRGINIA | No |
| 4 | 324500000X | Substance Abuse Rehabilitation Facility | | | | No |
| 5 | 363LF0000X | Nurse Practitioner | Family | | WEST VIRGINIA | No |
| 6 | 207P00000X | Emergency Medicine | | | | No |
| 7 | 207Q00000X | Family Medicine | | | KENTUCKY | No |
| 8 | 261QM0801X | Clinic/Center | Mental Health (Including Community Mental Health Center) | | | No |
| 9 | 363LP2300X | Nurse Practitioner | Primary Care | | | No |
| 10 | 363LF0000X | Nurse Practitioner | Family | | OHIO | No |
| 11 | 261QU0200X | Clinic/Center | Urgent Care | | | No |
| 12 | 363L00000X | Nurse Practitioner | | | | No |
| 13 | 363LF0000X | Nurse Practitioner | Family | | KENTUCKY | No |
| 14 | 207Q00000X | Family Medicine | | 1222241 | OHIO | Yes |
