Basic Information
Provider Information
NPI: 1427409481
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TRAUGHBER
FirstName: RACHEL
MiddleName: W.
NamePrefix:  
NameSuffix:  
Credential:  
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OtherLastName:  
OtherFirstName:  
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Mailing Information
Address1: 4200 GARDINER VIEW AVE STE 101
Address2:  
City: LOUISVILLE
State: KY
PostalCode: 402131877
CountryCode: US
TelephoneNumber: 5024560494
FaxNumber: 5024560496
Practice Location
Address1: 4200 GARDINER VIEW AVE STE 101
Address2:  
City: LOUISVILLE
State: KY
PostalCode: 402131877
CountryCode: US
TelephoneNumber: 5024560494
FaxNumber: 5024560496
Other Information
ProviderEnumerationDate: 06/30/2016
LastUpdateDate: 06/30/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X3010417KYY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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