PRACTICARE HOME CARE SERVICES LLC NPI 1265943716

NPI Information

NPI: 1265943716
Provider Name: PRACTICARE HOME CARE SERVICES, LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 18D2187630

Address:
1667 RUSSELL LEE DR
LOUISVILLE, KY
ZIP 40211
Phone: (502) 609-0589
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PRACTICARE HOME CARE SERVICES, LLC is a family nurse practitioner in Louisville, KY. PRACTICARE HOME CARE SERVICES, LLC NPI is 1265943716. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1667 RUSSELL LEE DR
LOUISVILLE, KY
ZIP 40211
Phone: (502) 609-0589

The provider's authorized official is Dephany Bibb .
The authorized official title is Owner/provider and has the following contact phone number (502) 609-0589.

The CLIA number assigned to this NPI record is 18D2187630 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/23/2017 and was last updated on 4/15/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	7100188560	MEDICAID	KENTUCKY
2	K029120	OTHER	KENTUCKY	MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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