Basic Information
Provider Information
NPI: 1003153776
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MIHALYOV
FirstName: AIMEE
MiddleName: CHRISTINE
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 257 KENOAK DR
Address2:  
City: LOUISVILLE
State: KY
PostalCode: 402142777
CountryCode: US
TelephoneNumber: 5025746617
FaxNumber: 5025748666
Practice Location
Address1: 400 E GRAY ST
Address2:  
City: LOUISVILLE
State: KY
PostalCode: 402021740
CountryCode: US
TelephoneNumber: 5025746617
FaxNumber: 5025746617
Other Information
ProviderEnumerationDate: 01/14/2013
LastUpdateDate: 03/19/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/19/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X1139470KYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

ID Information
IDTypeStateIssuerDescription
710030566005KY MEDICAID


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