Individual
MRS. MARY LEE PANTESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
924 E BROADWAY, LOUISVILLE, KY 40204-1057
(502) 200-1335
(502) 200-8904
Mailing address
817 S JACKSON ST, LOUISVILLE, KY 40203-2431
(502) 259-8811
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
4005705
KY
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
4005705
KY
363L00000X
Nurse Practitioner
Primary
4004705
KY
363LF0000X
Family Nurse Practitioner
Primary
4005705
KY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
4004705
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100912570
—
KY
05
—
7100936110
—
KY
Enumeration date
06/26/2023
Last updated
07/27/2026
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