Provider Demographics
NPI:1588909287
Name:HOLLAND, KATHERINE KUSTES (APRN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:KUSTES
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHERINE
Other - Last Name:KUSTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-559-9408
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:4915 NORTON HEALTHCARE BLVD STE 203
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2861
Practice Address - Country:US
Practice Address - Phone:502-423-9595
Practice Address - Fax:502-719-0161
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0185113163W00000X
KY1133433163W00000X
KY3007804363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100349330Medicaid
KY3007804OtherLICENSE
KYK073953Medicare PIN
KYK073956Medicare PIN
KY7100349330Medicaid
KYK073952Medicare PIN
KYK073951Medicare PIN
KYK073957Medicare PIN