Healthcare Provider Details

I. General information

NPI: 1285076018
Provider Name (Legal Business Name): EMILY DIANE FREEMAN APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY DIANE ELLIS APRN

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9520 ORMSBY STATION RD
LOUISVILLE KY
40223-5017
US

IV. Provider business mailing address

100 E LIBERTY ST SUITE 800
LOUISVILLE KY
40202-1434
US

V. Phone/Fax

Practice location:
  • Phone: 502-426-0606
  • Fax: 502-426-0604
Mailing address:
  • Phone: 502-495-2400
  • Fax: 502-495-6345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3008179
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3008179
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: