Healthcare Provider Details

I. General information

NPI: 1548090533
Provider Name (Legal Business Name): THOMAS R STREETMAN DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: THOMAS R STREETMAN DNP THOMAS S

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8305 SHEPHERDSVILLE RD
LOUISVILLE KY
40219-4532
US

IV. Provider business mailing address

8305 SHEPHERDSVILLE RD
LOUISVILLE KY
40219-4532
US

V. Phone/Fax

Practice location:
  • Phone: 202-209-5212
  • Fax:
Mailing address:
  • Phone: 202-209-5212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3049622
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1762536
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number3049622
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: