Provider Demographics
NPI:1093283053
Name:TROUTMAN, KATHLEEN (APRN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:TROUTMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11116 SANDWOOD PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-5301
Mailing Address - Country:US
Mailing Address - Phone:502-419-4830
Mailing Address - Fax:
Practice Address - Street 1:110 W JOHN ROWAN BLVD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2663
Practice Address - Country:US
Practice Address - Phone:502-337-7409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily