Healthcare Provider Details

I. General information

NPI: 1962250365
Provider Name (Legal Business Name): YENDRIS LICET CUESTA GARCIA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7926 PRESTON HWY STE 210
LOUISVILLE KY
40219-3848
US

IV. Provider business mailing address

5604 SPICEWOOD LN
LOUISVILLE KY
40219-1023
US

V. Phone/Fax

Practice location:
  • Phone: 502-371-0022
  • Fax: 502-394-3620
Mailing address:
  • Phone: 786-578-1239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4023866
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: