MEDICARE: MADISON CHARLOTTE NITZ

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	2255A2300X	Athletic Trainer		KY

General Provider Information

NPI Number	:	1164352217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON CHARLOTTE NITZ

Provider Business Mailing Address
First Line	:	1501 BELLAMY PL
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40208-3701
Country	:	US
Telephone Number	:	513-454-4021
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 SOUTH LIMESTONE ST
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503
Country	:	US
Telephone Number	:	859-323-1100
Fax Number	:

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

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/29/2026

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Directions to “ MADISON CHARLOTTE NITZ ” Practice Location

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