Provider Demographics
NPI:1912533423
Name:MAYPRAY, PLESHETTE
Entity Type:Individual
Prefix:
First Name:PLESHETTE
Middle Name:
Last Name:MAYPRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10243 RIVERSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-5228
Mailing Address - Country:US
Mailing Address - Phone:502-381-0338
Mailing Address - Fax:
Practice Address - Street 1:10243 RIVERSTONE CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-5228
Practice Address - Country:US
Practice Address - Phone:502-381-0338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYFAMIMedicaid