Healthcare Provider Details

I. General information

NPI: 1528036100
Provider Name (Legal Business Name): JUAWANNA L SCHULLER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4071 TATES CREEK CENTRE DR SUITE 100
LEXINGTON KY
40517-3062
US

IV. Provider business mailing address

230 LEXINGTON GREEN CIR STE 600
LEXINGTON KY
40503-3326
US

V. Phone/Fax

Practice location:
  • Phone: 859-273-3888
  • Fax: 859-272-3256
Mailing address:
  • Phone: 859-971-4695
  • Fax: 859-971-4604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3002500
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: