MEDICARE: MRS. MONICA CAROL GRIFFITH 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	71002054A	IN
2	363L00000X	Nurse Practitioner	3004429	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000770823	OTHER	KY	ANTHEM - NCMA/DUPONT
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000775339	OTHER	KY	ANTHEM - NCMA/BRECKENRIDGE
4	136935	OTHER	KY	SIHO - NCMA BRECKENRIDGE LN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	136933	OTHER	KY	SIHO-NCMA-DUPONT
7	50040433	OTHER	KY	PASSPORT - NCMA DUPONT

General Provider Information

NPI Number	:	1699759902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MONICA CAROL GRIFFITH APRN

Provider Business Mailing Address
First Line	:	PO BOX 776351
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6351
Country	:	US
Telephone Number	:	502-588-9490
Fax Number	:	502-272-5116

Provider Business Practice Location Address
First Line	:	9340 CEDAR CENTER WAY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-4522
Country	:	US
Telephone Number	:	502-239-8431
Fax Number	:

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	03/07/2023

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