Provider Demographics
NPI:1003147539
Name:FLAKE, TRICIA L (ARNP)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:L
Last Name:FLAKE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4402 CHURCHMAN AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-3102
Mailing Address - Country:US
Mailing Address - Phone:502-367-6322
Mailing Address - Fax:502-380-3843
Practice Address - Street 1:4402 CHURCHMAN AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-3102
Practice Address - Country:US
Practice Address - Phone:502-367-6322
Practice Address - Fax:502-380-3843
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY63309363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily