Healthcare Provider Details

I. General information

NPI: 1689179400
Provider Name (Legal Business Name): TINA LOUISE FOLEY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2018
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7926 PRESTON HWY STE 106
LOUISVILLE KY
40219-3848
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 210-951-9300
  • Fax:
Mailing address:
  • Phone: 502-272-5134
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF02180363
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3012312
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number763281
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: