WELLSPACE PSYCHIATRY LLC NPI 1710694468

NPI Information

  • NPI: 1710694468
  • Provider Name: WELLSPACE PSYCHIATRY LLC
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Organization
  • Doing Business As: WELLSPACE PSYCHIATRY
  • Address: 9700 PARK PLAZA AVE UNIT 210
    LOUISVILLE, KY
    ZIP 40241
  • Phone: (502) 419-4289

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NPI Details

WELLSPACE PSYCHIATRY LLC is a psychiatric/mental health nurse practitioner in Louisville, KY. WELLSPACE PSYCHIATRY LLC NPI is 1710694468. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Wellspace Psychiatry.

The provider's business location address is:

9700 PARK PLAZA AVE UNIT 210
LOUISVILLE, KY
ZIP 40241-287
Phone: (502) 419-4289

The provider's authorized official is Thomas J Federer .
The authorized official title is Owner/administrator and has the following contact phone number (502) 419-4289.

The enumeration date for this NPI number is 11/2/2022 and was last updated on 7/25/2023.

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
1363LP0808XNurse PractitionerPsychiatric/Mental HealthYes

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
11730733783OTHERNPI 1
23013601OTHERKENTUCKYAPRN LICENSE
37100639170MEDICAIDKENTUCKY
41128009OTHERKENTUCKYRN LICENSE

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: 11/21/2025

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