Healthcare Provider Details

I. General information

NPI: 1407362015
Provider Name (Legal Business Name): CARMELITA YVETTE MOPPINS APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 ABRAHAM FLEXNER WAY STE 502
LOUISVILLE KY
40202-1896
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 502-588-7690
  • Fax:
Mailing address:
  • Phone: 502-588-7690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3011407
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: