Central Kentucky Dermatology PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 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

Last updated

Jul 10, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Todd Clark, MDNPI 1205078664

Title

Medical Director

Phone

(859) 608-9917

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Todd V Clark, M.D.

  • Dermatology Physician
  • Nicholasville, KY
  • NPI 1205078664
  Medicare reassignment Care Compare group NPD Authorized official
• Hannah Elizabeth Noger, PA-C

  • Physician Assistant
  • Nicholasville, KY
  • NPI 1598314726
  Medicare reassignment Care Compare group
• Victoria A Yatsuknenko, PA-C

  • Physician Assistant
  • Louisville, KY
  • NPI 1013168715
  Medicare reassignment Care Compare group
• Anne Meredith Oakes, PA-C

  • Physician Assistant
  • Nicholasville, KY
  • NPI 1477403368
  NPD

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

{
    "created_epoch": "1663632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752105600000",
    "number": "1124741780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "249 E BRANNON RD",
            "city": "NICHOLASVILLE",
            "state": "KY",
            "postal_code": "403568059",
            "telephone_number": "859-354-5455",
            "fax_number": "859-203-8833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "249 E BRANNON RD",
            "city": "NICHOLASVILLE",
            "state": "KY",
            "postal_code": "403568059",
            "telephone_number": "859-354-5455",
            "fax_number": "859-203-8833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL KENTUCKY DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-20",
        "last_updated": "2025-07-10",
        "certification_date": "2025-07-10",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "859-608-9917",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fallon Michelle Carnes, MSW, LCSW
• Carol a. Wilson, DMD, PLLC (Jessamine Dental)
• Laura Carver
• Grace M Cates
• Hannah Caudill
• Lindsay Cha, MA, CCC-SLP
• Elisabeth Jones Chang, M.D.
• Philip En Chang, PHARMD
• Ali Imran Cheema, MD
• Samantha Brianna Chenot

• Dermatology Physician in Nicholasville, KY
• Providers in Nicholasville, KY by specialty
• Dermatology Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.