Provider Demographics
NPI:1164315461
Name:MARTIN MARTINEZ, MABEL (APRN-CNP)
Entity type:Individual
Prefix:
First Name:MABEL
Middle Name:
Last Name:MARTIN MARTINEZ
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8306 CREEK TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-2774
Mailing Address - Country:US
Mailing Address - Phone:502-295-5439
Mailing Address - Fax:
Practice Address - Street 1:4350 BROWNSBORO RD STE 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-1681
Practice Address - Country:US
Practice Address - Phone:502-244-2420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4038644207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine