Individual
MR. BRIAN KEITH GACKENBACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
530 S JACKSON ST, LOUISVILLE, KY 40202-1675
(502) 217-1053
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0328
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
3009514
KY
Other
Enumeration date
07/08/2015
Last updated
08/17/2015
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