Healthcare Provider Details

I. General information

NPI: 1457839441
Provider Name (Legal Business Name): KAYLA BROOKE TROUTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AUDUBON PLAZA DR
LOUISVILLE KY
40217-1318
US

IV. Provider business mailing address

PO BOX 36218
LOUISVILLE KY
40233-6218
US

V. Phone/Fax

Practice location:
  • Phone: 502-634-6767
  • Fax: 502-634-6775
Mailing address:
  • Phone: 502-634-6767
  • Fax: 502-634-6775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTC743
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: