Provider Demographics
NPI:1295027258
Name:CASSIDY, KAREN ANN (APRN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:CASSIDY
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 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-587-4391
Mailing Address - Fax:502-407-3048
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2877
Practice Address - Country:US
Practice Address - Phone:502-587-4391
Practice Address - Fax:502-407-3048
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3000959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201035760AMedicaid
KY78000577Medicaid
KYK014480Medicare PIN