MEDICARE: EMILY ISABELLA O'BRIEN

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	4015045	KY
2	163W00000X	Registered Nurse	4015045	KY

General Provider Information

NPI Number	:	1699615815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ISABELLA O'BRIEN

Provider Business Mailing Address
First Line	:	4402 CHURCHMAN AVE STE 201
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40215-3100
Country	:	US
Telephone Number	:	502-416-0207
Fax Number	:

Provider Business Practice Location Address
First Line	:	4402 CHURCHMAN AVE STE 201
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40215-3100
Country	:	US
Telephone Number	:	502-416-0207
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2026
Last Update Date	:	05/28/2026

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