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General NPI Number Information
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NPI Number | 1902695786
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Entity Type | Individual
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Provider Name | KATIE SUTHERLAND
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Gender | Female
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 12204 SHELBYVILLE RD
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City | MIDDLETOWN
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State | KY
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Zip | 40243-1450
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Country | US
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Telephone | 502-200-5228
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Fax |
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Provider Business Mailing Address
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Address Line | 12116 BAY RUN DR
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City | LOUISVILLE
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State | KY
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Zip | 40245-6402
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Country | US
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Telephone | 502-802-4440
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4038586
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License Number State | KY
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