Provider Demographics
NPI:1386928034
Name:KRAUTH, ALISON LEA (APRN)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:LEA
Last Name:KRAUTH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9510 ORMSBY STATION RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4082
Mailing Address - Country:US
Mailing Address - Phone:502-327-1000
Mailing Address - Fax:855-632-8329
Practice Address - Street 1:1724 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4916
Practice Address - Country:US
Practice Address - Phone:502-327-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007108363LA2100X
IN71003825A363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12312064OtherCAQH
IN201094710Medicaid