Healthcare Provider Details

I. General information

NPI: 1255325163
Provider Name (Legal Business Name): LAURA C SCHRADER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA CUNNINGHAM ARNP

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 YORKSHIRE MEDICAL PARK
LEXINGTON KY
40509
US

IV. Provider business mailing address

3480 YORKSHIRE MEDICAL PARK
LEXINGTON KY
40509-1886
US

V. Phone/Fax

Practice location:
  • Phone: 859-263-5140
  • Fax: 859-263-5141
Mailing address:
  • Phone: 859-263-5140
  • Fax: 859-263-5141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1082803
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3302P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: