MEDICARE: MEGAN ELIZABETH CARLISLE 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	3018995	KY

General Provider Information

NPI Number	:	1083302632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN ELIZABETH CARLISLE APRN

Provider Business Mailing Address
First Line	:	PO BOX 909
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40201-0909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10300 DIXIE HWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40272-3952
Country	:	US
Telephone Number	:	502-995-7775
Fax Number	:

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

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	05/19/2023

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