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PROVEN COSMETIC DERMATOLOGY LLC

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Company Details

Name: PROVEN COSMETIC DERMATOLOGY LLC
Legal type: Kentucky Limited Liability Company
Status: Active
Standing: Good
Profit or Non-Profit: Profit
File Date: 12 Mar 2020 (5 years ago)
Organization Date: 12 Mar 2020 (5 years ago)
Last Annual Report: 06 Mar 2024 (a year ago)
Managed By: Managers
Organization Number: 1090793
Industry: Health Services
Number of Employees: Small (0-19)
ZIP code: 41042
City: Florence
Primary County: Boone County
Principal Office: 8275 EWING BLVD., FLORENCE, KY 41042
Place of Formation: KENTUCKY

Organizer

Name Role
MONIKA L. RATHNAYAKE Organizer
SUSAN JO BUSHELMAN Organizer

Manager

Name Role
Suan Bushelman Manager

Registered Agent

Name Role
SUSAN JO BUSHELMAN Registered Agent

National Provider Identifier

NPI Number:
1811663198
Certification Date:
2021-08-18

Authorized Person:

Name:
DR. SUSAN BUSHELMAN
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
207N00000X - Dermatology Physician
Is Primary:
Yes

Contacts:

Fax:
8592831066

Assumed Names

Name Status Expiration Date
DERMATOLOGY AESTHETICS OF NORTHERN KENTUCKY Expiring 2025-05-14

Filings

Name File Date
Annual Report 2024-03-06
Principal Office Address Change 2023-10-23
Registered Agent name/address change 2023-10-23
Principal Office Address Change 2023-08-14
Annual Report 2023-03-21

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Sources: Kentucky Secretary of State