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Individual

TIA PATRICE BRAXTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
6540 OUTER LOOP STE 6, LOUISVILLE, KY 40228-2000
(502) 255-1925
Mailing address
8813 ARISTIDES DR, LOUISVILLE, KY 40258-1735
(502) 999-2855

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
3018206
KY

Other

Enumeration date
08/16/2022
Last updated
08/19/2022
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