Provider Demographics
NPI:1952886681
Name:PRICE, DESIREE R (DNP, AGNP-C)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:R
Last Name:PRICE
Suffix:
Gender:F
Credentials:DNP, AGNP-C
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:502-227-2575
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:210 E GRAY ST STE 700
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3903
Practice Address - Country:US
Practice Address - Phone:502-629-5400
Practice Address - Fax:502-629-5492
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012287363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology