Healthcare Provider Details

I. General information

NPI: 1609386267
Provider Name (Legal Business Name): ANNICA YVETTE SIZEMORE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNICA Y SIZEMORE FNP

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3165 S 2ND ST
LOUISVILLE KY
40208-1446
US

IV. Provider business mailing address

PO BOX 932958
CLEVELAND OH
44193-0028
US

V. Phone/Fax

Practice location:
  • Phone: 502-689-0838
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29300
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4010291
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number226525
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1145408
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: