=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144115379
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAIMILYS ALBA VERDECIA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2025
-----------------------------------------------------
Last Update Date | 10/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7926 PRESTON HWY
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40219-3848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-861-4655
-----------------------------------------------------
Fax | 502-861-4554
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11106 COMPASS AVE
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40229-8391
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-270-8404
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 4038649
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | 4038649
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------