Kentucky Blue Medical LLC

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

Legal business name

KENTUCKY BLUE MEDICAL LLC

Practice address

4602 Southern Pkwy Ste 1a
Louisville, KY 40214-1442

Phone

(502) 361-1159

NPI assigned

Jun 15, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Cranston Sheppard

Title

Owner

Phone

(502) 361-1159

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465948800000",
    "number": "1063862506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4602 SOUTHERN PKWY STE 1A",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402141442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4602 SOUTHERN PKWY STE 1A",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402141442",
            "telephone_number": "502-361-1159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENTUCKY BLUE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-15",
        "last_updated": "2016-06-15",
        "status": "A",
        "authorized_official_last_name": "SHEPPARD",
        "authorized_official_first_name": "CRANSTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "502-361-1159"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Neuromusculoskeletal Medicine & OMM Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Neuromusculoskeletal Medicine & OMM Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.