Healthcare Provider Details

I. General information

NPI: 1912873167
Provider Name (Legal Business Name): LOU CLARA COULON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E MAIN ST
PROVIDENCE KY
42450-1261
US

IV. Provider business mailing address

215 E MAIN ST
PROVIDENCE KY
42450-1261
US

V. Phone/Fax

Practice location:
  • Phone: 270-667-7017
  • Fax: 270-667-9065
Mailing address:
  • Phone: 270-667-7017
  • Fax: 270-667-9065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4049020
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: