Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 63309 | KY |
NPI | 1003147539 |
---|---|
Provider Name | Tricia L. Flake |
First Address | Louisville, KY 40215-3102 |
Second Address | Louisville, KY 40215-3102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2010 |
Last Update Date | 07/07/2014 |