MEDICARE: RICKEY ALLEN COSBY 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	17677	TN
2	363LF0000X	Family Nurse Practitioner	17677	TN
3	363LF0000X	Family Nurse Practitioner	CTP.19109	OH
4	363LF0000X	Family Nurse Practitioner	3009651	KY

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

General Provider Information

NPI Number	:	1730526864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICKEY ALLEN COSBY APRN

Provider Business Mailing Address
First Line	:	3939 7TH STREET RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-4103
Country	:	US
Telephone Number	:	502-883-6800
Fax Number	:	502-384-2316

Provider Business Practice Location Address
First Line	:	3939 7TH STREET RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-4103
Country	:	US
Telephone Number	:	502-883-6800
Fax Number	:	502-384-2316

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

Provider Enumeration Date	:	05/30/2013
Last Update Date	:	10/08/2024

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Directions to “ RICKEY ALLEN COSBY APRN” Practice Location

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