MEDICARE: AILYN ARIAS QUIJANO NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4023958	KY

General Provider Information

NPI Number	:	1003652405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AILYN ARIAS QUIJANO NP

Provider Business Mailing Address
First Line	:	2202 BUECHEL AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-2672
Country	:	US
Telephone Number	:	502-456-0494
Fax Number	:

Provider Business Practice Location Address
First Line	:	2202 BUECHEL AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-2672
Country	:	US
Telephone Number	:	502-456-0494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2024
Last Update Date	:	02/07/2025

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