Provider Demographics
NPI:1114497583
Name:JUSTICE, MICHELLE D (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:D
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:821 ORMSBY LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40242-4533
Mailing Address - Country:US
Mailing Address - Phone:502-468-1600
Mailing Address - Fax:
Practice Address - Street 1:821 ORMSBY LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40242-4533
Practice Address - Country:US
Practice Address - Phone:502-468-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012847363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily