Provider Demographics
NPI:1750634093
Name:JARVIS, KARLA MARIE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KARLA
Middle Name:MARIE
Last Name:JARVIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8134 NEW LAGRANGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4929
Mailing Address - Country:US
Mailing Address - Phone:502-822-3659
Mailing Address - Fax:502-709-4637
Practice Address - Street 1:8134 NEW LAGRANGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4677
Practice Address - Country:US
Practice Address - Phone:502-822-3659
Practice Address - Fax:502-709-4637
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3007742363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100223530Medicaid
KYK064133Medicare PIN