Provider Demographics
NPI:1508205113
Name:MATCHESWALA, KATHERINE (MSN, APRN, FNP, BSN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MATCHESWALA
Suffix:
Gender:F
Credentials:MSN, APRN, FNP, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:502-253-4914
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:305 LETTON DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-2252
Practice Address - Country:US
Practice Address - Phone:859-522-0001
Practice Address - Fax:859-522-0004
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008097363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily