Healthcare Provider Details

I. General information

NPI: 1184366643
Provider Name (Legal Business Name): DEANNA JEAN VALDIVIA APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEANNA JEAN VALDIVIA RN, MSN, APRN

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9880 ANGIES WAY STE 420
LOUISVILLE KY
40241-2850
US

IV. Provider business mailing address

359 S PEAK AVE
SHEPHERDSVILLE KY
40165-6888
US

V. Phone/Fax

Practice location:
  • Phone: 502-394-6200
  • Fax:
Mailing address:
  • Phone: 502-531-2280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3017659
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3017659
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: