MEDICARE: MABEL MARTIN MARTINEZ APRN-CNP

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	4038644	KY

General Provider Information

NPI Number	:	1164315461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MABEL MARTIN MARTINEZ APRN-CNP

Provider Business Mailing Address
First Line	:	8306 CREEK TRAIL CT
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-2774
Country	:	US
Telephone Number	:	502-295-5439
Fax Number	:

Provider Business Practice Location Address
First Line	:	4350 BROWNSBORO RD STE 200
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-1681
Country	:	US
Telephone Number	:	502-244-2420
Fax Number	:

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

Provider Enumeration Date	:	06/03/2025
Last Update Date	:	07/01/2025

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