Healthcare Provider Details

I. General information

NPI: 1740792746
Provider Name (Legal Business Name): PAOLA ROMERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 LILY CREEK RD STE 103
LOUISVILLE KY
40243-2815
US

IV. Provider business mailing address

1321 MURFREESBORO PIKE STE 702
NASHVILLE TN
37217-2679
US

V. Phone/Fax

Practice location:
  • Phone: 270-702-4641
  • Fax: 615-577-5654
Mailing address:
  • Phone: 844-359-7629
  • Fax: 615-577-5654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133001019
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: