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General NPI Number Information
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NPI Number | 1821360017
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Entity Type | Organization
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Legal Business Name | VERRALAB JA LLC
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 03/28/2022
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Provider Practice Location Address
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Address Line | 716 W MAIN ST STE 100A
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City | LOUISVILLE
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State | KY
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Zip | 40202-2777
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Country | US
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Telephone | 502-566-3588
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Fax | 502-561-0089
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Provider Business Mailing Address
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Address Line | 716 W MAIN ST STE 100A
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City | LOUISVILLE
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State | KY
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Zip | 40202-2777
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Country | US
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Telephone | 502-566-3588
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Fax | 502-566-0089
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Authorized Official
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Title or Position | PRESIDENT
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Name | KRISTEN REYNOLDS
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Credential | PHD
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Telephone | 502-566-3588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | KY
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