Healthcare Provider Details

I. General information

NPI: 1497229728
Provider Name (Legal Business Name): MARY LAUREN HUFF APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10216 TAYLORSVILLE RD STE 150
LOUISVILLE KY
40299-3616
US

IV. Provider business mailing address

2700 STANLEY GAULT PKWY STE 129
LOUISVILLE KY
40223-5176
US

V. Phone/Fax

Practice location:
  • Phone: 502-297-8900
  • Fax: 502-240-5679
Mailing address:
  • Phone: 502-253-4900
  • Fax: 502-489-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3012771
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: