Provider Demographics
NPI:1134496870
Name:SWIFT, VICKY ANN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:VICKY
Middle Name:ANN
Last Name:SWIFT
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:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-253-1035
Mailing Address - Fax:502-253-1037
Practice Address - Street 1:3900 KRESGE WAY
Practice Address - Street 2:SUITE 60
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4660
Practice Address - Country:US
Practice Address - Phone:502-893-7710
Practice Address - Fax:502-893-1884
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007156363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY133734OtherSIHO - NCC
KY000000755027OtherANTHEM - NCC
KY50037216OtherPASSPORT - NCC
KY50044389OtherPASSPORT - NCVA
KY000000787377OtherANTHEM - NCVA
KY133734OtherSIHO - NCVA
IN201060270Medicaid
KY7100198160Medicaid
IN201060270Medicaid