Healthcare Provider Details

I. General information

NPI: 1285470690
Provider Name (Legal Business Name): MILK MUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2024
Last Update Date: 07/04/2024
Certification Date: 07/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10602 TIMBERWOOD CIR
LOUISVILLE KY
40223-5367
US

IV. Provider business mailing address

3702 SUDBURY LN
LOUISVILLE KY
40220-2766
US

V. Phone/Fax

Practice location:
  • Phone: 502-424-5735
  • Fax:
Mailing address:
  • Phone: 502-424-5735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: KATELYN MORROW
Title or Position: CLINICAL DIRECTOR
Credential: RN, IBCLC
Phone: 502-424-5735