Healthcare Provider Details

I. General information

NPI: 1245725159
Provider Name (Legal Business Name): NAKESHA N MANSFIELD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NAKESHA N BRYANT RN

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CHESTNUT ST UNIT 370
LOUISVILLE KY
40202
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 502-562-6510
  • Fax: 502-562-6515
Mailing address:
  • Phone: 502-588-0325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3012532
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1103752
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: