Healthcare Provider Details

I. General information

NPI: 1336477140
Provider Name (Legal Business Name): AZRA ALOMEROVIC APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 NEWBURG RD STE 210
LOUISVILLE KY
40218-2458
US

IV. Provider business mailing address

3430 NEWBURG RD STE 210
LOUISVILLE KY
40218-2458
US

V. Phone/Fax

Practice location:
  • Phone: 502-454-8800
  • Fax: 502-736-0140
Mailing address:
  • Phone: 502-454-8800
  • Fax: 502-736-0140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6269P
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3006269
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: