Provider Demographics
NPI:1609386267
Name:SIZEMORE, ANNICA YVETTE (FNP)
Entity Type:Individual
Prefix:
First Name:ANNICA
Middle Name:YVETTE
Last Name:SIZEMORE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANNICA
Other - Middle Name:Y
Other - Last Name:SIZEMORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 932958
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3165 S 2ND ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-1446
Practice Address - Country:US
Practice Address - Phone:502-689-0838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN226525163W00000X
KY1145408163W00000X
TN29300363LF0000X
KY4010291363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse