Healthcare Provider Details

I. General information

NPI: 1902401268
Provider Name (Legal Business Name): KATIE M ESQUIBEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 SHELBYVILLE RD STE 121
LOUISVILLE KY
40222-5586
US

IV. Provider business mailing address

8401 SHELBYVILLE RD STE 121
LOUISVILLE KY
40222-5586
US

V. Phone/Fax

Practice location:
  • Phone: 502-936-6546
  • Fax:
Mailing address:
  • Phone: 502-936-6546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number293080
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: