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NPI Code Detail

MEDICARE: VICKI LYNN LARUE WHNP

MEDICARE: VICKI LYNN LARUE WHNP
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
1363LW0102XWomen's Health Nurse Practitioner71001441AIN
2363LW0102XWomen's Health Nurse Practitioner3003839KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932158516
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICKI LYNN LARUE WHNP
Provider Business Mailing Address
First Line : 3015 WILSON AVE
Second Line :
City : LOUISVILLE
State : KY
Zip : 40211-1969
Country : US
Telephone Number : 502-774-4401
Fax Number : 833-471-8264
Provider Business Practice Location Address
First Line : 3015 WILSON AVE
Second Line :
City : LOUISVILLE
State : KY
Zip : 40211-1969
Country : US
Telephone Number : 502-774-4401
Fax Number : 833-471-8264
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2006
Last Update Date : 08/14/2023

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