Healthcare Provider Details

I. General information

NPI: 1770035651
Provider Name (Legal Business Name): BETHANY D YAGER HOUZE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 10/11/2020
Certification Date: 10/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 E CHESTNUT ST
LOUISVILLE KY
40202-1821
US

IV. Provider business mailing address

PO BOX 776879
CHICAGO IL
60677-6879
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-6000
  • Fax: 502-629-5991
Mailing address:
  • Phone: 502-588-0982
  • Fax: 502-588-0987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3010598
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: