Healthcare Provider Details

I. General information

NPI: 1073293171
Provider Name (Legal Business Name): EMILY K CULLUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2944 BRECKENRIDGE LN
LOUISVILLE KY
40220-1409
US

IV. Provider business mailing address

516 HIGHWOOD DR
LOUISVILLE KY
40206-3295
US

V. Phone/Fax

Practice location:
  • Phone: 502-995-5525
  • Fax: 770-615-6091
Mailing address:
  • Phone: 205-470-9557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002932A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number300876
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: