Provider Demographics
NPI:1952748576
Name:BIRD, LARA ELIZABETH (APRN)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:ELIZABETH
Last Name:BIRD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:ELIZABETH
Other - Last Name:COIRATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-238-2801
Mailing Address - Fax:502-238-2835
Practice Address - Street 1:3900 KRESGE WAY STE 51
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4683
Practice Address - Country:US
Practice Address - Phone:502-259-5955
Practice Address - Fax:502-259-5953
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1120718163W00000X
KY3008063363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100247030Medicaid
IN201178280AMedicaid