Provider Demographics
NPI:1851373617
Name:NYAN & ASSOCIATES, PSC
Entity Type:Organization
Organization Name:NYAN & ASSOCIATES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIA/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISABELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:NYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-587-0111
Mailing Address - Street 1:801 BARRET AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1733
Mailing Address - Country:US
Mailing Address - Phone:502-587-0111
Mailing Address - Fax:502-587-9112
Practice Address - Street 1:801 BARRET AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1733
Practice Address - Country:US
Practice Address - Phone:502-587-0111
Practice Address - Fax:502-587-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30599207V00000X
363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200421820AMedicaid
KY65920647Medicaid
KY78901915Medicaid
KY65920647Medicaid