1487035069 NPI number — HAYLEY LIU APRN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487035069 NPI number — HAYLEY LIU APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIU
Provider First Name:
HAYLEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDERSON
Provider Other First Name:
HAYLEY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487035069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 EAST LIBERTY
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202-1438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-540-3339
Provider Business Mailing Address Fax Number:
502-479-1425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5129 DIXIE HWY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40216-1727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-447-3338
Provider Business Practice Location Address Fax Number:
502-595-7007
Provider Enumeration Date:
06/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  3009423 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100358270 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: K159411 . This is a "MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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