Healthcare Provider Details

I. General information

NPI: 1386619146
Provider Name (Legal Business Name): PATRICIA COLLINS MARTIN RN MAMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 PARK PLAZA AVENUE SUITE 105
LOUISVILLE KY
40241
US

IV. Provider business mailing address

9700 PARK PLAZA AVENUE SUITE 105
LOUISVILLE KY
40241
US

V. Phone/Fax

Practice location:
  • Phone: 502-327-0209
  • Fax:
Mailing address:
  • Phone: 502-327-0209
  • Fax: 502-426-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberKY0530
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1051501
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: