1. Home
  2. Directory
  3. Kentucky
  4. Georgetown
  5. Nurse Practitioner
  6. NPI Profile

GEORGETOWN PEDIATRICS, PSC
NPI 1275179020
Nurse Practitioner - Pediatrics in Georgetown, KY

Active since November 26, 2019CLIA 18D0322348 · Waiver
1162 LEXINGTON RD, GEORGETOWN, KY 40324(502) 863-6426(502) 868-9724 Get Directions Write a Review

NPPES record last updated: April 12, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Apr 12, 2023, Nov 26, 2019 (2 updates tracked since 2019).

About Georgetown Pediatrics, Psc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GEORGETOWN PEDIATRICS, PSC (NPI 1275179020) is a healthcare organization registered as a pediatrics in Georgetown, Kentucky and active in the NPI registry since November 2019. The organization holds a CLIA Waiver certificate valid through October 20, 2026 and lists Johanne Goodykoontz, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1275179020
Entity TypeOrganization
Primary Taxonomy363LP0200X
Legal Business NameGEORGETOWN PEDIATRICS, PSC
Location Address1162 LEXINGTON RDGeorgetown, KY 40324-9330
Mailing Address1162 Lexington RdGeorgetown, KY 40324-9330 · (502) 863-6426 · Fax (502) 868-9724
Phone(502) 863-6426
Fax(502) 868-9724
Organization SubpartNo
Authorized OfficialJohanne GoodykoontzOffice Manager · (502) 863-6426
Enumeration DateNovember 26, 2019
Last NPPES UpdateApril 12, 20232 updates tracked since enumeration
NPPES CertifiedApril 12, 2023
✔ NPI 1275179020 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · PediatricsPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0200X
Also ListedSocial Worker · ClinicalTaxonomy 1041C0700X
1162 LEXINGTON RD, Georgetown, KY 40324
Open in Google Maps ↗

Other Names 1

Doing Business AsGeorgetown Pediatrics, Psc

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 18D0322348

Georgetown Pediatrics Psc · Georgetown, KY
Active · expires Oct 20, 2026
CLIA Number18D0322348
Laboratory TypePhysician Office
Certificate Effective DateOctober 21, 2024
Certificate Expiration DateOctober 20, 2026
Laboratory DirectorHorace P. Hambrick
Laboratory Phone(502) 863-6426
Laboratory LocationGeorgetown Pediatrics Psc1162 Lexington Road, Georgetown, KY 40324
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. LACEY SWEIGART MD
Pediatrics
1162 LEXINGTON RD
GEORGETOWN, KY 40324
Scott County (502) 863-6426
DR. KRISTY K. MENKE M.D.
Pediatrics
1162 LEXINGTON RD
GEORGETOWN, KY 40324
Scott County (502) 863-6426
WILLIAM LEE GREY DO
Pediatrics
1162 LEXINGTON RD
GEORGETOWN, KY 40324
Scott County (502) 863-6426
DR. JENNIFER S. OLIVER M.D.
Pediatrics
1162 LEXINGTON RD
GEORGETOWN, KY 40324
Scott County (502) 863-6426
GEORGETOWN PEDIATRICS, PSC
Pediatrics
1162 LEXINGTON RD
GEORGETOWN, KY 40324
Scott County (502) 863-6426
DR. CYNTHIA KATIE SMALLWOOD M.D.
Pediatrics
1162 LEXINGTON RD
GEORGETOWN, KY 40324
Scott County (502) 863-6426
JAMIE DOTY LPCC
Counselor (Professional)
1162 LEXINGTON RD
GEORGETOWN, KY 40324
Scott County (502) 863-6426
DR. JENNIFER S. RIEBEL M.D.
Pediatrics
1162 LEXINGTON RD
GEORGETOWN, KY 40324
Scott County (502) 863-6426

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Georgetown Pediatrics, Psc's NPI number?

The NPI number for Georgetown Pediatrics, Psc is 1275179020. It was assigned to this organization in the NPPES registry on November 26, 2019.

Where is Georgetown Pediatrics, Psc located?

Georgetown Pediatrics, Psc is located at 1162 Lexington Rd, Georgetown, KY 40324. The listed phone number is (502) 863-6426.

What is Georgetown Pediatrics, Psc's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.

Does Georgetown Pediatrics, Psc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 18D0322348) is associated with this NPI, valid through October 20, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Georgetown Pediatrics, Psc was last updated on April 12, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.