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General NPI Number Information
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NPI Number | 1477419315
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Entity Type | Individual
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Provider Name | ELVIS LESTER MENDOZA VALLE MSN, APRN, AGNP-C
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Gender | Male
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Dates
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Enumeration Date | 01/03/2026
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Last Update Date | 01/03/2026
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Provider Practice Location Address
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Address Line | 11406 CASWELL SPRINGS WAY
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City | LOUISVILLE
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State | KY
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Zip | 40291-8328
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Country | US
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Telephone | 502-953-2657
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Fax |
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Provider Business Mailing Address
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Address Line | 11406 CASWELL SPRINGS WAY
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City | LOUISVILLE
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State | KY
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Zip | 40291-8328
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | AG01260001
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License Number State | KY
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