Provider Demographics
NPI:1336721224
Name:SKG HEALTH PLLC
Entity Type:Organization
Organization Name:SKG HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGLIARDI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:502-830-0321
Mailing Address - Street 1:5516 RANDOM WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-1822
Mailing Address - Country:US
Mailing Address - Phone:502-830-0321
Mailing Address - Fax:866-902-0669
Practice Address - Street 1:5516 RANDOM WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-1822
Practice Address - Country:US
Practice Address - Phone:502-830-0321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3006941OtherSTATE LICENSE