Healthcare Provider Details

I. General information

NPI: 1134496870
Provider Name (Legal Business Name): VICKY ANN SWIFT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 KRESGE WAY SUITE 60
LOUISVILLE KY
40207-4660
US

IV. Provider business mailing address

PO BOX 950248
LOUISVILLE KY
40295-0248
US

V. Phone/Fax

Practice location:
  • Phone: 502-893-7710
  • Fax: 502-893-1884
Mailing address:
  • Phone: 502-253-1035
  • Fax: 502-253-1037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007156
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: