Healthcare Provider Details

I. General information

NPI: 1720462252
Provider Name (Legal Business Name): SHIH-CHIA CHUNG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 CHURCHMAN AVE STE 300
LOUISVILLE KY
40215-3101
US

IV. Provider business mailing address

100 E LIBERTY ST STE 800
LOUISVILLE KY
40202-1428
US

V. Phone/Fax

Practice location:
  • Phone: 502-363-0588
  • Fax: 502-363-0972
Mailing address:
  • Phone: 502-540-3383
  • Fax: 502-540-3393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number00000
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3011778
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: