Individual
LAUREN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5129 DIXIE HWY STE 201, LOUISVILLE, KY 40216-1727
(502) 430-6223
(502) 792-7272
Mailing address
5129 DIXIE HWY STE 201, LOUISVILLE, KY 40216-1727
(502) 430-6223
(502) 792-7272
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1122125
KY
363LF0000X
Family Nurse Practitioner
Primary
3016840
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100857320
—
KY
Enumeration date
10/08/2021
Last updated
11/08/2022
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