Provider Demographics
NPI:1548930563
Name:HENDRIX, TAYLOR LEA (DNP, BSN, APRN, CPNP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LEA
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:DNP, BSN, APRN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-1317
Mailing Address - Country:US
Mailing Address - Phone:219-476-5243
Mailing Address - Fax:
Practice Address - Street 1:3333 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4613
Practice Address - Country:US
Practice Address - Phone:502-452-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28229144A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics