MRS. KLARISA NICOLE STOUDEMIRE (NPI# 1750619995) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750619995 |
| Entity Type | Individual |
| Full Name | MRS. KLARISA NICOLE STOUDEMIRE |
| Credential | ARNP |
| Practice Address |
3015 Wilson Ave Louisville KY 40211-1969 |
| Mailing Address |
Po Box 776347 Chicago IL 60677-6347 |
| Practice Telephone | 5027744401 |
| Practice Fax Number | 5027724783 |
| Mailing Telephone | 5025889490 |
| Mailing Fax Number | 5022725116 |
| Enumeration Date | 2009-11-30 |
| Last Update Date | 2017-11-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
3006498 | KY | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 300007238 | 05 | |
| KY | 7100172130 | 05 | |
| KY | MEDICARE | K008131 | 01 |
| KY | PASSPORT | 50132455 | 01 |
| KY | ANTHEM | 000001092683 | 01 |
| KY | SIHO | 229581 | 01 |
| Street Address |
3015 WILSON AVE |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40211-1969 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275534091 | Lisa G Glass | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2005-08-02 |
| 1083215362 | Yazmine Jaquez | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-11-04 |
| 1982211405 | Domini Williams | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-09-29 |
| 1497361091 | Treana Redd | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-09-18 |
| 1356954366 | Janneve Sankawulo | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-08-28 |
| 1588274260 | Robyn May | Dentist | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-08-06 |
| 1124638184 | Symone Stephens | Registered Nurse | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-08-05 |
| 1275151292 | Park Duvalle Community Health Center, Inc | Clinic/Center | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-07-07 |
| 1598312415 | Elissa Grider | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2019-08-26 |
| 1730733783 | Mark A Bush | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211 | 2019-07-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942792940 | Kare LLC | Dentist | 2500 W Broadway Ste 500, Louisville, KY 40211 | 2018-06-05 |
| 1265943716 | Practicare Home Care Services, LLC | Nurse Practitioner | 1667 Russell Lee Dr, Louisville, KY 40211 | 2017-10-23 |
| 1518478221 | Latoya Samantha Hall | Counselor | 646 South 36th Street, Louisville, KY 40211 | 2017-10-20 |
| 1003071200 | Mark Cassol Md Psc | Ophthalmology | 2600 W. Broadway, Suite 105, Louisville, KY 40211 | 2008-07-28 |
| 1194919548 | Hardin Housing Corp | Assisted Living Facility | 2035 S 41st St, Louisville, KY 40211 | 2007-08-29 |
| 1184770562 | Eta Day Care Center LLC | Case Management | 724 So 44th Street, Louisville, KY 40211 | 2007-01-26 |
| 1871571356 | Alice C Gunnison | Physician Assistant | 2406 West Broadway, Jencare Neighborhood Medical Center West Broadway, LLC, Louisville, KY 40211 | 2006-01-05 |
| 1730694266 | Orchid House, Inc. | Early Intervention Provider Agency | 703 S 31st St, Louisville, KY 40211 | 2017-12-06 |
| 1891188785 | Mary Jo Pitts | Registered Nurse | 2406 West Broadway, Jencare Neighborhood Medical Center West Broadway, LLC, Louisville, KY 40211 | 2015-03-17 |
| 1164717492 | Priscilla Nana Ama Owusu | Internal Medicine | 2406 W Broadway, Louisville, KY 40211 | 2011-06-15 |
| Find all providers in zip 40211 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023618535 | Pamela Nicole Kinney | Nurse Practitioner | 13503 Terrace Creek Dr Apt 203, Louisville, KY 40245-5838 | 2020-10-26 |
| 1457950883 | Tetteh Narteh | Nurse Practitioner | 10200 Linn Station Rd Ste 125, Louisville, KY 40223-3889 | 2020-10-16 |
| 1114525540 | Richard A Anane | Nurse Practitioner | 10200 Linn Station Rd Ste 300, Louisville, KY 40223-3841 | 2020-10-16 |
| 1427656081 | Elma Mustic | Nurse Practitioner | 9714 Boxford Way, Louisville, KY 40242-2305 | 2020-10-15 |
| 1679171318 | Cassandra Jane Lee | Nurse Practitioner | 3416 Imperator Ln Unit 103, Louisville, KY 40245-7752 | 2020-10-14 |
| 1942817762 | Merritt Borders | Nurse Practitioner | 1602 Hunnington Pl Apt 4, Louisville, KY 40220-3771 | 2020-09-25 |
| 1114533536 | Lyssa Alexandra Miller | Nurse Practitioner | 5120 Dixie Hwy Ste 101, Louisville, KY 40216-1775 | 2020-09-21 |
| 1174138713 | Paola Cristina Maldonado | Nurse Practitioner | 14719 Eddington Way Apt 304, Louisville, KY 40245-5581 | 2020-09-10 |
| 1033722525 | Bynisha Robertson | Nurse Practitioner | 5312 Sprigwood Ln, Louisville, KY 40291-1135 | 2020-08-25 |
| 1154931202 | Heather M Karem | Nurse Practitioner | 10207 Hartley Dr, Louisville, KY 40223-2735 | 2020-08-04 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40211 |
Please comment or provide details below to improve the information on MRS. KLARISA NICOLE STOUDEMIRE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.