Healthcare Provider Details

I. General information

NPI: 1861287625
Provider Name (Legal Business Name): ANN LAUREN FIEPKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 SPRING ST
JEFFERSONVILLE IN
47130-3700
US

IV. Provider business mailing address

2598 FILSON AVE
LOUISVILLE KY
40217-2040
US

V. Phone/Fax

Practice location:
  • Phone: 812-920-1580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number1149042
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: