Central Kentucky Dermatology PLLC
Organization Active NPI Dermatology Physician · Nicholasville, KY
NPI 1124741780 · NPPES record last updated Jul 10, 2025
Key facts
- NPI
- 1124741780
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- CENTRAL KENTUCKY DERMATOLOGY PLLC
- Practice address
- 249 E Brannon Rd
Nicholasville, KY 40356-8059 - Phone
- (859) 354-5455
- Fax
- (859) 203-8833
- NPI assigned
- Sep 20, 2022
- Organization subpart
- No
Authorized official
- Name
- Todd Clark, MD
- Title
- Medical Director
- Phone
- (859) 608-9917
Practitioners 3
-
Todd V Clark, M.D.
-
Hannah Elizabeth Noger, PA-C
-
Victoria A Yatsuknenko, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221114001903 | KY | Part B Supplier - Clinic/Group Practice | 2860869351 |
Receives reassigned benefits from 3 practitioners Practice locations: Frankfort, KY; Nicholasville, KY |
National Provider Directory
Locations
231 E Brannon Rd
Ste 249
Nicholasville, KY 40356
615 E Brannon Rd
Ste 220
Nicholasville, KY 40356
Phone (859) 354-5455
249 E Brannon Rd
Nicholasville, KY 40356
Phone (859) 354-5455
231 E Brannon Rd
Nicholasville, KY 40356
Phone (859) 271-0083
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes | ||
| Physician Assistant |
363A00000X |
Addresses
Primary practice location
249 E Brannon Rd
Nicholasville, KY 40356-8059
Mailing address
249 E Brannon Rd
Nicholasville, KY 40356-8059
Phone (859) 354-5455
Other providers in Nicholasville, KY
- Carol a. Wilson, DMD, PLLC
- Amanda Mae Carpenter
- Laura Carver
- Grace M Cates
- Hannah Caudill
- Lindsay Cha
- Philip En Chang
- Ali Imran Cheema
- Samantha Brianna Chenot
- Chiro One Wellness Center of Nicholasville PLLC
All providers in Nicholasville, KY · Dermatology Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.