Individual
MADISON JOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2400 EASTPOINT PKWY # 350, LOUISVILLE, KY 40223-4154
(502) 928-8970
Mailing address
2400 EASTPOINT PKWY # 350, LOUISVILLE, KY 40223-4154
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4059362
KY
Other
Enumeration date
06/03/2026
Last updated
06/03/2026
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