Provider Demographics
NPI:1548090533
Name:STREETMAN, THOMAS T III (APRN)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:T
Last Name:STREETMAN
Suffix:III
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:TREY
Other - Middle Name:
Other - Last Name:STREETMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:8305 SHEPHERDSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-4532
Mailing Address - Country:US
Mailing Address - Phone:864-372-6664
Mailing Address - Fax:
Practice Address - Street 1:8305 SHEPHERDSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-4532
Practice Address - Country:US
Practice Address - Phone:864-321-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1762536163W00000X
KY3049622363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse