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General NPI Number Information
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NPI Number | 1588450472
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Entity Type | Individual
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Provider Name | SUSAN REDDICK APRN
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Gender | Female
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 3615 E JOHN ROWAN BLVD STE 104
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City | BARDSTOWN
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State | KY
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Zip | 40004-3264
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Country | US
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Telephone | 502-348-5968
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Fax |
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Provider Business Mailing Address
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Address Line | 919 N 3RD ST
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City | BARDSTOWN
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State | KY
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Zip | 40004-2639
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Country | US
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Telephone | 502-275-9753
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F03250284
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License Number State | KY
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