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General NPI Number Information
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NPI Number | 1821809153
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Entity Type | Organization
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Legal Business Name | 2022 LLC
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 700 GAGEL AVE
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City | LOUISVILLE
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State | KY
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Zip | 40216-4008
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Country | US
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Telephone | 502-963-5516
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Fax | 502-963-5704
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Provider Business Mailing Address
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Address Line | 4104 SMARTY JONES DR
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City | LOUISVILLE
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State | KY
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Zip | 40214-6530
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Country | US
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Telephone | 502-759-6281
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Fax | 502-772-1533
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Authorized Official
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Title or Position | OWNER
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Name | XAVIER GILES
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Credential |
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Telephone | 502-384-0939
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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 |
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License Number State |
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Taxonomy #2
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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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