Individual
MARY LORENE TEXAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
4309 BISHOP LN, LOUISVILLE, KY 40218-4517
(502) 485-3387
(502) 485-3670
Mailing address
6903 BARBROOK RD, LOUISVILLE, KY 40258-2773
(502) 935-4163
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3006053
KY
363LF0000X
Family Nurse Practitioner
71002542B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000944673 (KOHMG)
ANTHEM
KY
Enumeration date
11/30/2007
Last updated
11/17/2015
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