Provider Demographics
NPI:1437433273
Name:LOVE, CATHERINE FORT (APRN)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:FORT
Last Name:LOVE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:MANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2700 STANLEY GAULT PKWY STE 129
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5176
Mailing Address - Country:US
Mailing Address - Phone:502-489-6613
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:3950 KRESGE WAY STE 303
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-928-0900
Practice Address - Fax:502-928-0901
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007140363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100187030Medicaid
IN201053140AMedicaid
KYK032830Medicare PIN
INM67156055Medicare PIN
KY7100187030Medicaid
KYP01027526 RRMedicare PIN