Basic Information
| Provider Information | |||||||||
| NPI: | 1821294042 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DENZIK | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3430 NEWBURG RD STE 210 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402182458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024548800 | ||||||||
| FaxNumber: | 5027360140 | ||||||||
| Practice Location | |||||||||
| Address1: | 3430 NEWBURG RD | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402182497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024548800 | ||||||||
| FaxNumber: | 5027360140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2007 | ||||||||
| LastUpdateDate: | 04/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0809X | 3002586 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult | 363LP0808X | 1064209 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 78007242 | 05 | KY | MEDICAID |