Provider Demographics
NPI:1932148897
Name:THRONEBERRY, SHEILA (ARNP)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:THRONEBERRY
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 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-272-5395
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:2355 POPLAR LEVEL RD
Practice Address - Street 2:STE. 301
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1395
Practice Address - Country:US
Practice Address - Phone:502-636-0406
Practice Address - Fax:502-636-5137
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP400033806OtherMEDICARE
KYK167152OtherNCMA MEDICARE
KY000000346469OtherANTHEM BCBS
KY78007374Medicaid
KY000000346469OtherANTHEM BCBS