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General NPI Number Information
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NPI Number | 1083083984
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Entity Type | Individual
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Provider Name | REECHA LUSBY
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Gender | Female
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Dates
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Enumeration Date | 09/21/2015
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Last Update Date | 03/22/2019
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Provider Practice Location Address
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Address Line | 189 OUTER LOOP STE. 2
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City | LOUISVILLE
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State | KY
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Zip | 40214-5544
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Country | US
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Telephone | 502-379-8870
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Fax | 502-394-3600
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5116
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | TC420
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2052
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License Number State | KY
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