Provider Demographics
NPI:1932754298
Name:OLDHAM, LAURA MICHELLE (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELLE
Last Name:OLDHAM
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:L
Other - Middle Name:MICHELLE
Other - Last Name:OLDHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, NP-C
Mailing Address - Street 1:805 BARDSTOWN RD STE 12
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40069-1515
Mailing Address - Country:US
Mailing Address - Phone:859-481-7113
Mailing Address - Fax:859-481-7114
Practice Address - Street 1:805 BARDSTOWN RD STE 12
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:KY
Practice Address - Zip Code:40069-1515
Practice Address - Country:US
Practice Address - Phone:859-481-7113
Practice Address - Fax:859-481-7114
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013691363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100631100Medicaid