Healthcare Provider Details

I. General information

NPI: 1205991817
Provider Name (Legal Business Name): ANDREA LYNN OHR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 S 7TH ST
LOUISVILLE KY
40208-1710
US

IV. Provider business mailing address

1505 S 7TH ST
LOUISVILLE KY
40208-1710
US

V. Phone/Fax

Practice location:
  • Phone: 502-637-1005
  • Fax: 502-637-5631
Mailing address:
  • Phone: 502-637-1005
  • Fax: 502-637-5631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5071P
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3005071
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: