Provider Demographics
NPI:1831140771
Name:PIRKLE, REBECCA P (C GNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:P
Last Name:PIRKLE
Suffix:
Gender:F
Credentials:C GNP
Other - Prefix:
Other - First Name:HARTLY GRIMES
Other - Middle Name:
Other - Last Name:PAMPLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:501 E BROADWAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-562-6810
Mailing Address - Fax:502-562-6777
Practice Address - Street 1:215 CENTRAL STATION
Practice Address - Street 2:102
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208
Practice Address - Country:US
Practice Address - Phone:502-852-7449
Practice Address - Fax:502-852-1423
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2639P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78005980Medicaid
KY0766158Medicare PIN
P31565Medicare UPIN
KY1271227Medicare PIN
KY78005980Medicaid
KY0631233Medicare PIN
KY0523928Medicare PIN