1679963607 NPI number — DANA ELIZABETH HUGHES APRN-FNP

Table of content: DANA ELIZABETH HUGHES APRN-FNP (NPI 1679963607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679963607 NPI number — DANA ELIZABETH HUGHES APRN-FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUGHES
Provider First Name:
DANA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN-FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TISDALE
Provider Other First Name:
DANA
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679963607
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 STANLEY GAULT PKWY
Provider Second Line Business Mailing Address:
SUITE 129
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40223-5132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-489-5730
Provider Business Mailing Address Fax Number:
502-489-5753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10216 TAYLORSVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
JEFFERSONTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40299-3616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-267-5456
Provider Business Practice Location Address Fax Number:
502-267-5488
Provider Enumeration Date:
01/29/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  3009192 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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