Provider Demographics
NPI:1184366643
Name:VALDIVIA, DEANNA JEAN (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:JEAN
Last Name:VALDIVIA
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:JEAN
Other - Last Name:VALDIVIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, MSN, APRN
Mailing Address - Street 1:359 S PEAK AVE
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-6888
Mailing Address - Country:US
Mailing Address - Phone:502-531-2280
Mailing Address - Fax:
Practice Address - Street 1:9880 ANGIES WAY STE 420
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2850
Practice Address - Country:US
Practice Address - Phone:502-394-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017659207R00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine