Healthcare Provider Details

I. General information

NPI: 1649848722
Provider Name (Legal Business Name): MICHELLE RHEA LOSE APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2327 LIME KILN LN
LOUISVILLE KY
40222-3422
US

IV. Provider business mailing address

3762 ROSEMONT BLVD
LOUISVILLE KY
40218-1567
US

V. Phone/Fax

Practice location:
  • Phone: 502-414-4557
  • Fax: 502-873-0021
Mailing address:
  • Phone: 502-472-3375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3016251
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: