MEDICARE: JOAN ALICE OSBORNE 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	363L00000X	Nurse Practitioner	3477P	KY
2	363LF0000X	Family Nurse Practitioner	3003477	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00220013	OTHER		RR MEDICARE PIN
4	4000501	OTHER	KY	MEDICARE LAB GROUP
5	CB5773	OTHER	KY	RR MEDICARE GROUP

Other Identifiers

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

General Provider Information

NPI Number	:	1285739797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN ALICE OSBORNE APRN

Provider Business Mailing Address
First Line	:	12201 BLUEGRASS PKWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-2361
Country	:	US
Telephone Number	:	859-338-3958
Fax Number	:	859-368-8135

Provider Business Practice Location Address
First Line	:	1608 HILL RISE DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-2503
Country	:	US
Telephone Number	:	859-338-3958
Fax Number	:	859-368-8135

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/08/2017

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Directions to “ JOAN ALICE OSBORNE APRN” Practice Location

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