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General NPI Number Information
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NPI Number | 1568488609
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Entity Type | Organization
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Legal Business Name | THE LITTLE CLINIC, LLC
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2956 E 10TH ST
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-5914
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Country | US
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Telephone | 812-284-2488
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Fax |
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Provider Business Mailing Address
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Address Line | 9721 ORMSBY STATION RD STE 106
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City | LOUISVILLE
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State | KY
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Zip | 40223-4095
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Country | US
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Telephone | 502-423-1103
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Fax |
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Authorized Official
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Title or Position | SECRETARY OF ORGANIZATION
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Name | BRADLEY PRUITT
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Credential | ESQUIRE
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Telephone | 502-301-7408
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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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