Provider Demographics
NPI:1497862841
Name:KNOOP, COLLEEN D (ARNP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:D
Last Name:KNOOP
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E CHESTNUT ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-5700
Mailing Address - Country:US
Mailing Address - Phone:502-589-0802
Mailing Address - Fax:502-589-0805
Practice Address - Street 1:401 E CHESTNUT ST
Practice Address - Street 2:SUITE 510
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5700
Practice Address - Country:US
Practice Address - Phone:502-589-0802
Practice Address - Fax:502-589-0805
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4735P363L00000X
LAAP08497363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02105864Medicaid
KY000000388291OtherANTHEM
LA2405250Medicaid
KY000000388291OtherANTHEM
LA2405250Medicaid