Provider Demographics
NPI:1154431146
Name:GENNETT, ELAINE LITTLEJOHN (ARNP)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:LITTLEJOHN
Last Name:GENNETT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 WHITTINGTON PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4930
Mailing Address - Country:US
Mailing Address - Phone:502-327-9100
Mailing Address - Fax:502-742-3767
Practice Address - Street 1:140 WHITTINGTON PKWY
Practice Address - Street 2:STE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4930
Practice Address - Country:US
Practice Address - Phone:502-327-9100
Practice Address - Fax:502-742-3767
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9190849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY03ZHOtherBCBS
FL305822100Medicaid