Individual
JASON KEITH FACKLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
201 ABRAHAM FLEXNER WAY STE 1105, LOUISVILLE, KY 40202-3841
(502) 367-4500
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 367-4500
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
APRN11026036
FL
363LA2100X
Acute Care Nurse Practitioner
Primary
3019095
KY
Other
Enumeration date
04/28/2023
Last updated
09/17/2024
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