Healthcare Provider Details

I. General information

NPI: 1255948154
Provider Name (Legal Business Name): KATHLEEN B BERGHAUSEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9811 BROWNSBORO RD STE 101
LOUISVILLE KY
40241-5230
US

IV. Provider business mailing address

9811 BROWNSBORO RD STE 101
LOUISVILLE KY
40241-5230
US

V. Phone/Fax

Practice location:
  • Phone: 502-558-0916
  • Fax: 502-385-6687
Mailing address:
  • Phone: 502-558-0916
  • Fax: 502-385-6687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3015109
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: