=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144876814
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YOU ONLY LIVE ONCE MEDICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2019
-----------------------------------------------------
Last Update Date | 05/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 821 ULRICH AVE
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40219-1844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-230-2050
-----------------------------------------------------
Fax | 502-684-8480
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 821 ULRICH AVE
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40219-1844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-230-2050
-----------------------------------------------------
Fax | 502-684-8480
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER/CEO
-----------------------------------------------------
Name | KORTNEY ARNOLD
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 502-230-2050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------