Provider Demographics
NPI:1427521772
Name:COYLE, MARYSSA JEAN (APRN)
Entity type:Individual
Prefix:
First Name:MARYSSA
Middle Name:JEAN
Last Name:COYLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARYSSA
Other - Middle Name:JEAN
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2700 STANLEY GAULT PKWY STE 129
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5176
Mailing Address - Country:US
Mailing Address - Phone:502-253-4900
Mailing Address - Fax:502-489-5750
Practice Address - Street 1:225 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:DAWSON SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42408-2423
Practice Address - Country:US
Practice Address - Phone:270-797-3521
Practice Address - Fax:270-797-3292
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30127825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily