Healthcare Provider Details

I. General information

NPI: 1669964524
Provider Name (Legal Business Name): LINDSEY HEIBERT M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4835 POPLAR LEVEL RD STE 110
LOUISVILLE KY
40213-2906
US

IV. Provider business mailing address

5402 GREENWOOD RD
LOUISVILLE KY
40258-2326
US

V. Phone/Fax

Practice location:
  • Phone: 855-591-0092
  • Fax: 502-631-9660
Mailing address:
  • Phone: 502-544-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: