Healthcare Provider Details

I. General information

NPI: 1629682356
Provider Name (Legal Business Name): ANDI ALEXANDRIA VANCE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S LIMESTONE
LEXINGTON KY
40536-3839
US

IV. Provider business mailing address

401 HIGHLAND PARK DR
RICHMOND KY
40475-3839
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-2778
  • Fax: 859-257-8708
Mailing address:
  • Phone: 859-626-7700
  • Fax: 859-626-7890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3015011
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: