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General NPI Number Information
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NPI Number | 1043996911
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Entity Type | Individual
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Provider Name | MARY LEE PANTESS NP
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Gender | Female
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Dates
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Enumeration Date | 06/26/2023
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 3934 DIXIE HWY STE 420
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City | LOUISVILLE
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State | KY
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Zip | 40216-5162
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Country | US
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Telephone | 502-200-1335
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Fax | 866-715-7614
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Provider Business Mailing Address
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Address Line | 817 S JACKSON ST
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City | LOUISVILLE
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State | KY
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Zip | 40203-2431
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Country | US
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Telephone | 502-259-8811
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4005705
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License Number State | KY
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