Provider Demographics
NPI:1396880019
Name:DANIELS, NATALIE HOUSTON (MD)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:HOUSTON
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13802 LAKE POINT CIR STE 201
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4219
Mailing Address - Country:US
Mailing Address - Phone:502-245-4450
Mailing Address - Fax:502-245-4462
Practice Address - Street 1:13802 LAKE POINT CIR STE 201
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4219
Practice Address - Country:US
Practice Address - Phone:502-245-4450
Practice Address - Fax:502-245-4462
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR0692207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY41083OtherLICENSE
KYP00689182OtherRAILROAD MEDICARE
KY9703140OtherAETNA
KY000000569365OtherANTHEM
KY41083OtherLICENSE