MEDICARE: KATELYNN MARIE HERL PMHNP

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	4037076	KY
2	363LF0000X	Family Nurse Practitioner	4037076	KY
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4037076	KY

General Provider Information

NPI Number	:	1710686803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYNN MARIE HERL PMHNP

Provider Business Mailing Address
First Line	:	11411 EXPEDITION TRL
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-5068
Country	:	US
Telephone Number	:	502-777-7064
Fax Number	:

Provider Business Practice Location Address
First Line	:	10400 DIXIE HWY STE 103
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40272-5913
Country	:	US
Telephone Number	:	504-409-4013
Fax Number	:

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

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	01/09/2026

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