Healthcare Provider Details

I. General information

NPI: 1144692997
Provider Name (Legal Business Name): PATRICIA M WORTLEY AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MCDAVID BLVD
GRAYSON KY
41143-1603
US

IV. Provider business mailing address

12910 SHELBYVILLE RD SUITE 300
LOUISVILLE KY
40243-1593
US

V. Phone/Fax

Practice location:
  • Phone: 606-474-7835
  • Fax:
Mailing address:
  • Phone: 502-244-2441
  • Fax: 502-254-4069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number148705
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberSLPAUD00193936
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: