Healthcare Provider Details

I. General information

NPI: 1790185254
Provider Name (Legal Business Name): ASHLEY BROOKE MAIER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 NEWBURG RD STE 250
LOUISVILLE KY
40218-2458
US

IV. Provider business mailing address

3430 NEWBURG RD STE 250
LOUISVILLE KY
40218-2458
US

V. Phone/Fax

Practice location:
  • Phone: 502-893-3963
  • Fax: 502-897-1792
Mailing address:
  • Phone: 502-893-3963
  • Fax: 502-897-1792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3008909
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3008909
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: