Provider Demographics
NPI:1174653471
Name:FROMAN GLOVER, CHARLA JAYNETTE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CHARLA
Middle Name:JAYNETTE
Last Name:FROMAN GLOVER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-543-4119
Mailing Address - Fax:502-543-1462
Practice Address - Street 1:5100 OUTER LOOP
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-4056
Practice Address - Country:US
Practice Address - Phone:502-968-6226
Practice Address - Fax:502-966-5562
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYF1004066363LF0000X
KY3004438363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100010160Medicaid
KY7100010160Medicaid
KY00546108Medicare Oscar/Certification