| Vitae Health Medical Kentucky, Llc | |
|
3500 Good Samaritan Way Louisville KY 40299-6117 | |
| (704) 664-7494 | |
| Not Available |
| Full Name | Vitae Health Medical Kentucky, Llc |
|---|---|
| Speciality | Counselor |
| Location | 3500 Good Samaritan Way, Louisville, Kentucky |
| Authorized Official Name and Position | Jamie Lashley (PRESIDENT) |
| Authorized Official Contact | 3122626434 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitae Health Medical Kentucky, Llc 980 Sylvan Ave Englewood Cliffs NJ 07632-3315 Ph: (312) 262-6434 | Vitae Health Medical Kentucky, Llc 3500 Good Samaritan Way Louisville KY 40299-6117 Ph: (704) 664-7494 |
| NPI Number | 1629600879 |
|---|---|
| Provider Enumeration Date | 02/06/2020 |
| Last Update Date | 10/11/2025 |
| Certification Date | 10/11/2025 |
| Medicare PECOS PAC ID | 3173952637 |
|---|---|
| Medicare Enrollment ID | O20200403001181 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629600879 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Manoj H Majmudar |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1659336097 PECOS PAC ID: 7113981168 Enrollment ID: I20041118000661 |
| Provider Name | Osawaru Jude Omoruyi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396961967 PECOS PAC ID: 8921190992 Enrollment ID: I20090325000174 |
| Provider Name | Lela Cole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609104546 PECOS PAC ID: 1850433848 Enrollment ID: I20100129000183 |
| Provider Name | Mary Angela Rogers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891840542 PECOS PAC ID: 9234102427 Enrollment ID: I20101022000164 |
| Provider Name | Sandra Lucinda Hazelwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285915256 PECOS PAC ID: 9931373495 Enrollment ID: I20111117000753 |
| Provider Name | Brandi L Stacy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760722144 PECOS PAC ID: 8022253921 Enrollment ID: I20130325000529 |
| Provider Name | Deena D Carrico |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033577564 PECOS PAC ID: 9133428543 Enrollment ID: I20160505001108 |
| Provider Name | Jenny Thomas Holt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669927760 PECOS PAC ID: 0749568897 Enrollment ID: I20161025002073 |
| Provider Name | Delasaria Lihon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740504174 PECOS PAC ID: 6103184106 Enrollment ID: I20171221000198 |
| Provider Name | Aaron Smith |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1780099481 PECOS PAC ID: 9739426438 Enrollment ID: I20190201002057 |
| Provider Name | Brittany Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679106991 PECOS PAC ID: 6103254693 Enrollment ID: I20200316002070 |
| Provider Name | Victoria Lee Bivins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225663677 PECOS PAC ID: 9537599527 Enrollment ID: I20200414003387 |
| Provider Name | Jennifer Mcdowell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225378904 PECOS PAC ID: 0547406480 Enrollment ID: I20200618001783 |
| Provider Name | Rachel Elizabeth Sanders |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407356975 PECOS PAC ID: 9931513850 Enrollment ID: I20210203002809 |
| Provider Name | Marsheila J Tincher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679613517 PECOS PAC ID: 2567879174 Enrollment ID: I20210326002021 |
| Provider Name | Laura A Fieser |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083188668 PECOS PAC ID: 8527488642 Enrollment ID: I20210722002909 |
| Provider Name | Leslie Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104588854 PECOS PAC ID: 3971901224 Enrollment ID: I20211018001536 |
| Provider Name | Roy D Sellers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396410502 PECOS PAC ID: 3173912649 Enrollment ID: I20211123002473 |
| Provider Name | Bailey R Fuller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467119057 PECOS PAC ID: 2062899438 Enrollment ID: I20220525000193 |
| Provider Name | Megan Speed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235721150 PECOS PAC ID: 4385026038 Enrollment ID: I20220728000547 |
| Provider Name | Mikayla Anne Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568144053 PECOS PAC ID: 8123482809 Enrollment ID: I20230913003683 |
| Provider Name | Brittany Shingleton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720836687 PECOS PAC ID: 4284178963 Enrollment ID: I20240705001466 |
| Provider Name | Lyndsey West |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902583032 PECOS PAC ID: 8224569207 Enrollment ID: I20241001003048 |
| Provider Name | Kieonna Wadlington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336707959 PECOS PAC ID: 5890029490 Enrollment ID: I20241011002820 |
| Provider Name | Sara Ballard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437986544 PECOS PAC ID: 3779005772 Enrollment ID: I20250319002707 |
| Provider Name | Alison Clement |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235760273 PECOS PAC ID: 6709214620 Enrollment ID: I20250325000472 |
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