Provider Demographics
NPI:1841267887
Name:ANDRIAKOS, BOBETTE KATZ (ARNP)
Entity type:Individual
Prefix:
First Name:BOBETTE
Middle Name:KATZ
Last Name:ANDRIAKOS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-2500
Mailing Address - Fax:502-588-2501
Practice Address - Street 1:1941 BISHOP LN
Practice Address - Street 2:STE 900
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1922
Practice Address - Country:US
Practice Address - Phone:502-588-2500
Practice Address - Fax:502-588-2501
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3001497363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200345760Medicaid
KY78002060Medicaid
KY0766159Medicare PIN
KY1271142Medicare ID - Type Unspecified
IN200345760Medicaid