Elkhorn Dermatology PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

ELKHORN DERMATOLOGY PLLC

Practice address

304 Boston SQ
Georgetown, KY 40324-9786

Phone

(502) 316-9425

Fax

(502) 316-9451

NPI assigned

Mar 29, 2017

Last updated

Aug 24, 2020By 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

Chase Wilson, MDNPI 1053757641

Title

Owner

Phone

(502) 316-9425

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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.

• Chase Landon Wilson, M.D.

  • Dermatology Physician
  • Georgetown, KY
  • NPI 1053757641
  Medicare reassignment Care Compare group NPD Authorized official
• Kathryn Lauren Hayes, APRN

  • Family Nurse Practitioner
  • Lexington, KY
  • NPI 1831854934
  Medicare reassignment Care Compare group NPD
• Lily Abbott Hoover Walker, PA-C

  • Physician Assistant
  • Georgetown, KY
  • NPI 1184500795
  Medicare reassignment Care Compare group NPD
• Jessica Smith, APRN

  • Family Nurse Practitioner
  • Lexington, KY
  • NPI 1376996629
  Medicare reassignment NPD

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

{
    "created_epoch": "1490745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598227200000",
    "number": "1841722980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 BOSTON SQ",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403249786",
            "telephone_number": "502-316-9425",
            "fax_number": "502-316-9451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 BOSTON SQ",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403249786",
            "telephone_number": "502-316-9425",
            "fax_number": "502-316-9451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELKHORN DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-29",
        "last_updated": "2020-08-24",
        "certification_date": "2020-08-24",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "CHASE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "502-316-9425",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "KY",
            "license": "49577",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Eddington
• Deshay'Nia Nichole Edwards, RBT
• Taylor Grace Edwards
• Ashley Erin Elam, RN, DOULA
• Mobolanle Asope Elder, MD
• Lauren R Elliott, OT
• Marissa Renee Emery, DMD
• Alexandra Blaine Epley, APRN
• Amanda Grace Estep, MD
• Jared Estridge

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.