Provider Demographics
NPI:1144431354
Name:PROHASKA, JULIA K (PA)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:K
Last Name:PROHASKA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:STE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-363-0588
Mailing Address - Fax:502-363-0972
Practice Address - Street 1:4402 CHURCHMAN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1190
Practice Address - Country:US
Practice Address - Phone:502-363-0588
Practice Address - Fax:502-363-0972
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2018-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYPA246363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100089540Medicaid
KYP00752643OtherMEDICARE RR
KYPA246OtherKY MED. LICENSE
KY7100089540Medicaid