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NPI Code Detail

MEDICARE: EXTENDED CARE HEALTH PROFESSIONALS, PLLC

MEDICARE: EXTENDED CARE HEALTH PROFESSIONALS, PLLC
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
1363A00000XPhysician Assistant
2363L00000XNurse Practitioner
3363LF0000XFamily Nurse Practitioner
4207R00000XInternal Medicine Physician

Other Identifiers

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

General Provider Information

NPI Number : 1760563266
Entity Type Code : Organization
Provider Name (Legal Business Name) : EXTENDED CARE HEALTH PROFESSIONALS, PLLC
Provider Business Mailing Address
First Line : 3903 VANTAGE PL
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-6801
Country : US
Telephone Number : 502-356-4377
Fax Number : 888-959-2460
Provider Business Practice Location Address
First Line : 3903 VANTAGE PL
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-6801
Country : US
Telephone Number : 502-356-4377
Fax Number : 888-959-2460
Authorized Official
Title or Position : APRN
Name : KIM CASHION
Credential : APRN
Telephone Number : 502-396-7176
Provider Enumeration Date : 10/18/2006
Last Update Date : 02/05/2018

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