Healthcare Provider Details

I. General information

NPI: 1528557808
Provider Name (Legal Business Name): CARL AKIN III RN, EMT-P
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 TEXAS AVE
LOUISVILLE KY
40217-2237
US

IV. Provider business mailing address

1511 TEXAS AVE
LOUISVILLE KY
40217-2237
US

V. Phone/Fax

Practice location:
  • Phone: 502-664-9469
  • Fax:
Mailing address:
  • Phone: 502-664-9469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number1036811-1659
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number1133799
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: