Healthcare Provider Details

I. General information

NPI: 1225857550
Provider Name (Legal Business Name): MAKAYLA SKYLAR PAIGE HAAS APRN, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 LANCASHIRE AVE
LOUISVILLE KY
40205-2940
US

IV. Provider business mailing address

2104 LANCASHIRE AVE
LOUISVILLE KY
40205-2940
US

V. Phone/Fax

Practice location:
  • Phone: 859-797-3629
  • Fax:
Mailing address:
  • Phone: 859-797-3629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4029011
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1165566
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: