Provider Demographics
NPI:1487652434
Name:WARD, DOROTHY SHEILA
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:SHEILA
Last Name:WARD
Suffix:
Gender:F
Credentials:
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 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:3991 DUTCHMANS LN STE 108
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4700
Practice Address - Country:US
Practice Address - Phone:502-899-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY839P363LW0102X
KY839 P363LP0808X
KY839 M367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2446848000OtherPASSPORT ADVANTAGE - PSC
KY000000301524OtherANTHEM - FOUNDATION
KY78001229Medicaid
KY000000343086OtherANTHEM - PSC
KY2433490000OtherPASSPORT ADVANTAGE -PCP - FOUNDATION
KY2442509000OtherPASSPORT ADVANTAGE - SPECIALTY - FOUNDATION
KY50000849OtherPASSPORT SPECIALTY - FOUNDATION
KY50005542OtherPASSPORT SPECIALTY - PSC
IN200085870Medicaid
KY50000849OtherPASSPORT PCP-FOUNDATION
KY2446848000OtherPASSPORT ADVANTAGE - PSC
KY50000849OtherPASSPORT PCP-FOUNDATION
KYK040941Medicare PIN
KY0979702Medicare PIN