Provider Demographics
NPI:1790489284
Name:HUNTER, RAYSHAWN
Entity Type:Individual
Prefix:MS
First Name:RAYSHAWN
Middle Name:
Last Name:HUNTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4156 WESTPORT RD STE 214
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2705
Mailing Address - Country:US
Mailing Address - Phone:859-309-8552
Mailing Address - Fax:877-897-8103
Practice Address - Street 1:4156 WESTPORT RD STE 214
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2705
Practice Address - Country:US
Practice Address - Phone:859-309-8552
Practice Address - Fax:877-897-8103
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101YA0400X, 172A00000X, 253Z00000X, 376J00000X, 376K00000X
KY50093804374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No172A00000XOther Service ProvidersDriver
No253Z00000XAgenciesIn Home Supportive Care
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide