NPIMap

Organization Active NPI

Proven Cosmetic Dermatology

Doing business as Dermatology Aesthetics of Northern Kentucky

  • Dermatology Physician
  • Florence, KY
National Provider Identifier
1811663198
Registry record updated Aug 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
PROVEN COSMETIC DERMATOLOGY
Doing business as
Dermatology Aesthetics of Northern Kentucky
Practice address
7766 Ewing Blvd Ste 100
Florence, KY 41042-7538
Phone
(859) 283-1033
Fax
(859) 283-1066
NPI assigned
Aug 18, 2021
Last updated
Aug 18, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2021

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

Authorized official

Name
Dr. Susan Bushelman, MDNPI 1073632733
Title
Owner
Phone
(859) 802-4932

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

7766 Ewing Blvd Ste 100
Florence, KY 41042-7538

Mailing address

7766 Ewing Blvd Ste 100
Florence, KY 41042-7538
Phone (859) 283-1033

Other names 1

  • Dermatology Aesthetics of Northern Kentucky Doing business as

National Provider Directory

National Provider Directory

Locations

7766 Ewing Blvd
Ste 100
Florence, KY 41042
Phone (859) 283-1033

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1629244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629244800000",
    "number": "1811663198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7766 EWING BLVD STE 100",
            "city": "FLORENCE",
            "state": "KY",
            "postal_code": "410427538",
            "telephone_number": "859-283-1033",
            "fax_number": "859-283-1066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7766 EWING BLVD STE 100",
            "city": "FLORENCE",
            "state": "KY",
            "postal_code": "410427538",
            "telephone_number": "859-283-1033",
            "fax_number": "859-283-1066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVEN COSMETIC DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-18",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A",
        "authorized_official_last_name": "BUSHELMAN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "859-802-4932",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dermatology Aesthetics of Northern Kentucky",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Florence, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; 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.