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General NPI Number Information
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NPI Number | 1396631933
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Entity Type | Individual
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Provider Name | LAURA LYNN WAYMAN
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Gender | Female
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Dates
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Enumeration Date | 06/17/2025
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 124 CHESAPEAKE TRL
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City | COXS CREEK
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State | KY
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Zip | 40013-6627
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Country | US
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Telephone | 865-556-7012
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Fax |
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Provider Business Mailing Address
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Address Line | 845 S 3RD ST
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City | LOUISVILLE
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State | KY
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Zip | 40203-2213
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1141357
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License Number State | KY
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