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NPI Code Detail

MEDICARE: DAVID KOONCE APRN

MEDICARE: DAVID KOONCE 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
1363LF0000XFamily Nurse Practitioner3011930KY

General Provider Information

NPI Number : 1932617453
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID KOONCE APRN
Provider Business Mailing Address
First Line : 1729 FINCHVILLE RD
Second Line :
City : SHELBYVILLE
State : KY
Zip : 40065-9224
Country : US
Telephone Number : 415-902-3782
Fax Number :
Provider Business Practice Location Address
First Line : 3615 NEWBURG RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40218-3368
Country : US
Telephone Number : 502-909-0772
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2018
Last Update Date : 07/11/2020

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