Healthcare Provider Details

I. General information

NPI: 1669787297
Provider Name (Legal Business Name): LUCRETIA F HOVELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9080 TAYLORSVILLE RD
LOUISVILLE KY
40299-1750
US

IV. Provider business mailing address

9080 TAYLORSVILLE RD
LOUISVILLE KY
40299-1750
US

V. Phone/Fax

Practice location:
  • Phone: 502-499-9998
  • Fax: 502-499-5272
Mailing address:
  • Phone: 502-499-9998
  • Fax: 502-499-5272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number71003792A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3006542
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: