Healthcare Provider Details

I. General information

NPI: 1699094342
Provider Name (Legal Business Name): ANDREA NICOLE DOUD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE STE J201
LEXINGTON KY
40536-1821
US

IV. Provider business mailing address

231 E. CHESTNUT STREET
LOUISVILLE KY
40202
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-2522
  • Fax: 859-323-3918
Mailing address:
  • Phone: 313-570-7077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number49895
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number165395
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number49895
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: