=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972338895
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN WESTERFIELD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2024
-----------------------------------------------------
Last Update Date | 09/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4960 NORTON HEALTHCARE BLVD
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40241-2831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-446-8000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17401 FISHERVILLE WOODS DR
-----------------------------------------------------
City | FISHERVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40023-9779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-795-7293
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | TC036
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------