Basic Information
| Provider Information | |||||||||
| NPI: | 1104823905 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VILLARREAL | ||||||||
| FirstName: | KARI | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 THOMAS MORE PKWY | ||||||||
| Address2: | SUITE 280 | ||||||||
| City: | CRESTVIEW HILLS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410175465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594260800 | ||||||||
| FaxNumber: | 8594264140 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 THOMAS MORE PKWY | ||||||||
| Address2: | SUITE 280 | ||||||||
| City: | CRESTVIEW HILLS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410175465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594260800 | ||||||||
| FaxNumber: | 8594264140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 06/18/2014 | ||||||||
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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 | 363L00000X | 71001762A | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 3008426 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 000000380313 | 01 | IN | ANTHEM | OTHER | 78016268 | 05 | KY | MEDICAID | 0098779 | 05 | OH | MEDICAID | 200190950A | 05 | IN | MEDICAID | 306607332001 | 05 | IL | MEDICAID |