MEDICARE: ELIZABETH HARGIS APRN

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	3011429	KY
2	363L00000X	Nurse Practitioner	3011429	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3011429	OTHER	KY	NP LICENSE

General Provider Information

NPI Number	:	1063933877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH HARGIS APRN

Provider Business Mailing Address
First Line	:	9800 SHELBYVILLE RD STE 220
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-2992
Country	:	US
Telephone Number	:	502-429-8585
Fax Number	:	502-429-6157

Provider Business Practice Location Address
First Line	:	8109 BARDSTOWN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-3441
Country	:	US
Telephone Number	:	502-384-4555
Fax Number	:

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

Provider Enumeration Date	:	06/30/2017
Last Update Date	:	09/09/2019

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