Basic Information
| Provider Information | |||||||||
| NPI: | 1326391913 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEASOR | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 E LIBERTY ST | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021434 | ||||||||
| CountryCode: | US | ||||||||
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| FaxNumber: | 6063307825 | ||||||||
| Practice Location | |||||||||
| Address1: | 323 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400516319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023505191 | ||||||||
| FaxNumber: | 5023496599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2012 | ||||||||
| LastUpdateDate: | 07/25/2016 | ||||||||
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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 | 363LF0000X | 3007743 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 3007743 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 3007743 | 01 | KY | KENTUCKY STATE MEDICAL LICENSE | OTHER | 7100223570 | 05 | KY | MEDICAID | 78903556 | 05 | KY | MEDICAID |