MEDICARE: NYAN & ASSOCIATES, PSC

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
2	207V00000X	Obstetrics & Gynecology Physician	30599	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851373617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYAN & ASSOCIATES, PSC

Provider Business Mailing Address
First Line	:	801 BARRET AVE
Second Line	:	SUITE 210
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1733
Country	:	US
Telephone Number	:	502-587-0111
Fax Number	:	502-587-9112

Provider Business Practice Location Address
First Line	:	801 BARRET AVE
Second Line	:	SUITE 210
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1733
Country	:	US
Telephone Number	:	502-587-0111
Fax Number	:	502-587-9112

Authorized Official
Title or Position	:	PHYSICIA/OWNER
Name	:	ISABELLA NYAN
Credential	:	MD
Telephone Number	:	502-587-0111

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	08/05/2008

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Directions to “NYAN & ASSOCIATES, PSC ” Practice Location

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