=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376782680
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNA ZELICHENOK ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2009
-----------------------------------------------------
Last Update Date | 03/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4003 KRESGE WAY STE 312
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40207-4652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-899-7377
-----------------------------------------------------
Fax | 502-899-1972
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4003 KRESGE WAY SUITE 312
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40207-4652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-899-7377
-----------------------------------------------------
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 | 5839P
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------