Healthcare Provider Details

I. General information

NPI: 1245310564
Provider Name (Legal Business Name): JUDITH KAY GLADISH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CHESTNUT ST STE 410
LOUISVILLE KY
40202-5700
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 502-589-8637
  • Fax:
Mailing address:
  • Phone: 502-588-0329
  • Fax: 502-588-0326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3002301
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2301P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: