MEDICARE: ONE PEDIATRICS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2080A0000X	Pediatric Adolescent Medicine Physician
2	2080P0216X	Pediatric Rheumatology Physician
3	363A00000X	Physician Assistant
4	363L00000X	Nurse Practitioner
5	363LF0000X	Family Nurse Practitioner
6	363LP0200X	Pediatric Nurse Practitioner
7	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
8	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1063855450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE PEDIATRICS, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 950293
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40295-0293
Country	:	US
Telephone Number	:	502-292-8973
Fax Number	:

Provider Business Practice Location Address
First Line	:	6425 BARDSTOWN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-3040
Country	:	US
Telephone Number	:	502-762-0498
Fax Number	:	502-762-0469

Authorized Official
Title or Position	:	CMS
Name	:	LEA NUNES-VAIS
Credential	:
Telephone Number	:	502-292-8973

Provider Enumeration Date	:	04/16/2013
Last Update Date	:	06/28/2023

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