Provider Demographics
NPI:1639818867
Name:ACOSTA QUINTANA, ALEXEY
Entity Type:Individual
Prefix:
First Name:ALEXEY
Middle Name:
Last Name:ACOSTA QUINTANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7907 ROCHELLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40228-2379
Mailing Address - Country:US
Mailing Address - Phone:502-295-9826
Mailing Address - Fax:
Practice Address - Street 1:7907 ROCHELLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40228-2379
Practice Address - Country:US
Practice Address - Phone:502-295-9826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-04
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1171048163W00000X, 163WP0200X
KY4014131363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0200XNursing Service ProvidersRegistered NursePediatrics