Basic Information
Provider Information
NPI: 1801264866
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FOLLMER
FirstName: GABRIELLE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 140 WHITTINGTON PKWY
Address2: SUITE #100
City: LOUISVILLE
State: KY
PostalCode: 402224930
CountryCode: US
TelephoneNumber: 5023279100
FaxNumber: 8556328329
Practice Location
Address1: 140 WHITTINGTON PKWY
Address2: SUITE #100
City: LOUISVILLE
State: KY
PostalCode: 402224930
CountryCode: US
TelephoneNumber: 5023279100
FaxNumber: 8556328329
Other Information
ProviderEnumerationDate: 09/08/2015
LastUpdateDate: 09/08/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X3009531KYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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