Provider Demographics
NPI:1659191831
Name:SCHLEGEL, AUDREY F (PA-C)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:F
Last Name:SCHLEGEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4610
Mailing Address - Country:US
Mailing Address - Phone:812-797-0618
Mailing Address - Fax:
Practice Address - Street 1:1015 DUPONT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4610
Practice Address - Country:US
Practice Address - Phone:502-883-0227
Practice Address - Fax:502-410-0484
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC063363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical