Provider Demographics
NPI:1487951588
Name:RIPATO, CAROLYN (APRN)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:RIPATO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:9880 ANGIES WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2864
Practice Address - Country:US
Practice Address - Phone:502-446-6160
Practice Address - Fax:502-446-6161
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006794363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000776059OtherANTHEM PIN
KY158657OtherSIHO-NSS
KY50024332OtherPASSPORT-NNS
KY000000858857OtherANTHEM-NNS
KY7100208630Medicaid
KY7100208630Medicaid
KY50024332OtherPASSPORT-NNS