Wellspace Psychiatry LLC
Nurse Practitioner, Psych/Mental Health in Louisville, KY. Organization (NPI-2).
NPI number1710694468
StatusActive
Last updated in NPPESJul 25, 2023
Details
- NPI
- 1710694468
- Entity type
- Organization (NPI-2)
- Legal business name
- Wellspace Psychiatry LLC
- Organization subpart
- No
- Enumeration date
- Nov 2, 2022
- Certification date
- Feb 20, 2023
- Last updated
- Jul 25, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | – | – | Yes |
Other names
- Wellspace Psychiatry (Doing Business As)
Practice location
9700 Park Plaza Ave Unit 210Louisville, KY 40241-2287
Phone 502-419-4289
Mailing address
9700 Park Plaza Ave Unit 210Louisville, KY 40241-2287
Phone 502-419-4289
Authorized official
Thomas J Federer
Owner/Administrator
5024194289
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