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General NPI Number Information
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NPI Number | 1376901868
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ASSOCIATES OF LOUISVILLE, PLLC
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Dates
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Enumeration Date | 01/29/2016
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Last Update Date | 01/29/2016
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Provider Practice Location Address
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Address Line | 5721 BARDSTOWN RD
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City | LOUISVILLE
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State | KY
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Zip | 40291-1913
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Country | US
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Telephone | 502-231-1144
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Fax | 502-231-1508
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Provider Business Mailing Address
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Address Line | 5721 BARDSTOWN RD
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City | LOUISVILLE
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State | KY
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Zip | 40291-1913
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Country | US
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Telephone | 502-231-1144
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Fax | 502-231-1508
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Authorized Official
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Title or Position | BILLING
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Name | LISA PARIS
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Credential |
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Telephone | 502-231-1144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0200X
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Taxonomy Name | Pediatric Clinical Nurse Specialist
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License Number | 1065462
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License Number State | KY
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