Provider Demographics
NPI:1528448610
Name:A2 SKIN
Entity type:Organization
Organization Name:A2 SKIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:502-759-5240
Mailing Address - Street 1:2520 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2672
Mailing Address - Country:US
Mailing Address - Phone:502-759-5240
Mailing Address - Fax:
Practice Address - Street 1:2520 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2672
Practice Address - Country:US
Practice Address - Phone:502-759-5240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service