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General NPI Number Information
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NPI Number | 1023979903
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Entity Type | Organization
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Legal Business Name | SORELLE WELLNESS LLC
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Dates
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Enumeration Date | 11/20/2025
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 927 W MAIN ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-2621
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Country | US
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Telephone | 502-208-5787
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Fax | 502-690-4364
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Provider Business Mailing Address
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Address Line | 6803 FEGENBUSH LN
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City | LOUISVILLE
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State | KY
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Zip | 40228-1371
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Country | US
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Telephone | 502-208-5787
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Fax | 502-690-4364
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Authorized Official
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Title or Position | CEO/NURSE PRACTITIONER
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Name | MRS. SHAVON PRENTICE
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Credential | APRN
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Telephone | 502-767-8392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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