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General NPI Number Information
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NPI Number | 1184446643
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Entity Type | Organization
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Legal Business Name | RECOVERYALISTIC CORPORATION
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 813 S 40TH ST
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City | LOUISVILLE
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State | KY
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Zip | 40211-2837
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Country | US
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Telephone | 502-608-4471
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Fax |
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Provider Business Mailing Address
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Address Line | 813 S 40TH ST
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City | LOUISVILLE
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State | KY
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Zip | 40211-2837
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Country | US
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Telephone | 502-608-4471
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Fax | 502-290-0579
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Authorized Official
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Title or Position | OWNER
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Name | TONJALIA L TYUS
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Credential | APRN
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Telephone | 502-608-4471
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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 |
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License Number State |
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