Healthcare Provider Details

I. General information

NPI: 1093584716
Provider Name (Legal Business Name): JUMOKE OWOLABI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S PRESTON ST
LOUISVILLE KY
40202-1716
US

IV. Provider business mailing address

10401 LINN STATION RD STE 100
LOUISVILLE KY
40223-3842
US

V. Phone/Fax

Practice location:
  • Phone: 502-589-8600
  • Fax:
Mailing address:
  • Phone: 502-589-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4012033
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: