Basic Information
| Provider Information | |||||||||
| NPI: | 1811568017 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EXPRESS RECOVERY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 910 | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068781181 | ||||||||
| FaxNumber: | 6068773608 | ||||||||
| Practice Location | |||||||||
| Address1: | 93 CVB DR | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068781181 | ||||||||
| FaxNumber: | 6068773608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2021 | ||||||||
| LastUpdateDate: | 07/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | PHILPOT | ||||||||
| AuthorizedOfficialFirstName: | CHELSEY | ||||||||
| AuthorizedOfficialMiddleName: | BLAKE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6067672401 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | APRN | ||||||||
| NPICertificationDate: | 07/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.