Provider Demographics
NPI:1699571083
Name:IBANEZ HERNANDEZ, RAUL P SR (APRN)
Entity type:Individual
Prefix:MR
First Name:RAUL
Middle Name:P
Last Name:IBANEZ HERNANDEZ
Suffix:SR
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 EL PATIO PL APT 214
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-6005
Mailing Address - Country:US
Mailing Address - Phone:502-544-2755
Mailing Address - Fax:
Practice Address - Street 1:3828 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1527
Practice Address - Country:US
Practice Address - Phone:502-479-8930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAG02250080363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology