Provider Demographics
NPI:1326391913
Name:LEASOR, KAREN ANN (APRN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:LEASOR
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 1:100 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:
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:323 CENTER ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:KY
Practice Address - Zip Code:40051-6319
Practice Address - Country:US
Practice Address - Phone:502-350-5191
Practice Address - Fax:502-349-6599
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007743363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3007743OtherKENTUCKY STATE MEDICAL LICENSE
KY7100223570Medicaid
KY78903556Medicaid
KY7100223570Medicaid