MEDICARE: REBECCA F OLDS ARNP

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	363LF0000X	Family Nurse Practitioner	3107P	KY

General Provider Information

NPI Number	:	1952392037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA F OLDS ARNP

Provider Business Mailing Address
First Line	:	257 BLACKBERRY CIR
Second Line	:
City	:	MT WASHINGTON
State	:	KY
Zip	:	40047-6837
Country	:	US
Telephone Number	:	502-538-9819
Fax Number	:

Provider Business Practice Location Address
First Line	:	3430 NEWBURG RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-2497
Country	:	US
Telephone Number	:	502-451-1100
Fax Number	:	502-451-1181

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

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	07/08/2007

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