Provider Demographics
NPI:1104823905
Name:VILLARREAL, KARI (NP)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 THOMAS MORE PKWY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5465
Mailing Address - Country:US
Mailing Address - Phone:859-426-0800
Mailing Address - Fax:859-426-4140
Practice Address - Street 1:350 THOMAS MORE PKWY
Practice Address - Street 2:SUITE 280
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5465
Practice Address - Country:US
Practice Address - Phone:859-426-0800
Practice Address - Fax:859-426-4140
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001762A363L00000X
KY3008426363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000380313OtherANTHEM
KY78016268Medicaid
OH0098779Medicaid
IN200190950AMedicaid
IL306607332001Medicaid
IN000000380313OtherANTHEM
INP00285679Medicare ID - Type UnspecifiedRR
IN200190950AMedicaid
Q26661Medicare UPIN