Healthcare Provider Details

I. General information

NPI: 1568488609
Provider Name (Legal Business Name): THE LITTLE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2956 E 10TH ST
JEFFERSONVILLE IN
47130-5914
US

IV. Provider business mailing address

9721 ORMSBY STATION RD STE 106
LOUISVILLE KY
40223-4095
US

V. Phone/Fax

Practice location:
  • Phone: 812-284-2488
  • Fax:
Mailing address:
  • Phone: 502-423-1103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY PRUITT
Title or Position: SECRETARY OF ORGANIZATION
Credential: ESQUIRE
Phone: 502-301-7408