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CENTRAL KENTUCKY DERMATOLOGY, PLLC

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Company Details

Name: CENTRAL KENTUCKY DERMATOLOGY, PLLC
Legal type: Kentucky Limited Liability Company
Status: Active
Standing: Good
Profit or Non-Profit: Profit
File Date: 23 Sep 2022 (3 years ago)
Organization Date: 23 Sep 2022 (3 years ago)
Last Annual Report: 22 Jul 2024 (10 months ago)
Managed By: Members
Organization Number: 1233324
Industry: Health Services
Number of Employees: Small (0-19)
ZIP code: 40356
City: Nicholasville
Primary County: Jessamine County
Principal Office: 249 E BRANNON RD., NICHOLASVILLE, KY 40356
Place of Formation: KENTUCKY

Organizer

Name Role
TODD CLARK Organizer

Registered Agent

Name Role
TODD CLARK Registered Agent

Member

Name Role
Todd Clark Member

National Provider Identifier

NPI Number:
1124741780
Certification Date:
2023-01-12

Authorized Person:

Name:
TODD CLARK
Role:
MEDICAL DIRECTOR
Phone:

Taxonomy:

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

Contacts:

Form 5500 Series

Employer Identification Number (EIN):
920503857
Plan Year:
2023
Number Of Participants:
0
Sponsors Telephone Number:

Former Company Names

Name Action
CENTRAL KY DERMATOLOGY, PLLC Old Name

Filings

Name File Date
Annual Report 2024-07-22
Registered Agent name/address change 2024-07-22
Principal Office Address Change 2024-07-22
Annual Report 2023-05-17
Amendment 2022-09-29

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Sources: Kentucky Secretary of State