MEDICARE: QIYU HUANG 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	3007138	KY
2	363LF0000X	Family Nurse Practitioner	A130173	IA

General Provider Information

NPI Number	:	1619250131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QIYU HUANG APRN

Provider Business Mailing Address
First Line	:	4001 SARATOGA WOODS DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-4357
Country	:	US
Telephone Number	:	502-290-8155
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 DIXIE HWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40210-1745
Country	:	US
Telephone Number	:	502-772-1822
Fax Number	:

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

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	09/27/2022

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Directions to “ QIYU HUANG APRN” Practice Location

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