Healthcare Provider Details

I. General information

NPI: 1760563266
Provider Name (Legal Business Name): EXTENDED CARE HEALTH PROFESSIONALS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 VANTAGE PL
LOUISVILLE KY
40299-6801
US

IV. Provider business mailing address

3903 VANTAGE PL
LOUISVILLE KY
40299-6801
US

V. Phone/Fax

Practice location:
  • Phone: 502-356-4377
  • Fax: 888-959-2460
Mailing address:
  • Phone: 502-356-4377
  • Fax: 888-959-2460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KIM CASHION
Title or Position: APRN
Credential: APRN
Phone: 502-396-7176