MEDICARE: ELAINE LITTLEJOHN GENNETT ARNP

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	ARNP9190849	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y03ZH	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154431146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE LITTLEJOHN GENNETT ARNP

Provider Business Mailing Address
First Line	:	140 WHITTINGTON PKWY
Second Line	:	STE 100
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-4930
Country	:	US
Telephone Number	:	502-327-9100
Fax Number	:	502-742-3767

Provider Business Practice Location Address
First Line	:	140 WHITTINGTON PKWY
Second Line	:	STE 100
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-4930
Country	:	US
Telephone Number	:	502-327-9100
Fax Number	:	502-742-3767

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	04/27/2012

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