Provider Demographics
NPI:1487989687
Name:HEALTH SERVICES OF KENTUCKY, PLLC
Entity type:Organization
Organization Name:HEALTH SERVICES OF KENTUCKY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER/PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:SHROCK
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:502-314-7050
Mailing Address - Street 1:PO BOX 7766
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40257-0766
Mailing Address - Country:US
Mailing Address - Phone:502-314-7050
Mailing Address - Fax:502-245-5964
Practice Address - Street 1:122 N WATTERSON TRL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2700
Practice Address - Country:US
Practice Address - Phone:502-314-7050
Practice Address - Fax:502-245-5964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4426P261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1548389752OtherNPI - INDIVIDUAL
KY4426POtherNURSE PRACTITIONER LICENSE NUMBER