Provider Demographics
NPI:1770689838
Name:LOUVARIS, KATHY (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:LOUVARIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:1616 PHYSICIANS DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4619
Mailing Address - Country:US
Mailing Address - Phone:850-431-5119
Mailing Address - Fax:850-431-6105
Practice Address - Street 1:1616 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4619
Practice Address - Country:US
Practice Address - Phone:850-431-5119
Practice Address - Fax:850-431-6105
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN676362363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL762480800Medicaid
P43333Medicare UPIN
FLY0796ZMedicare ID - Type Unspecified