Provider Demographics
NPI:1699759902
Name:GRIFFITH, MONICA CAROL (APRN)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:CAROL
Last Name:GRIFFITH
Suffix:
Gender:F
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: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:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:9340 CEDAR CENTER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-4522
Practice Address - Country:US
Practice Address - Phone:502-239-8431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002054A363L00000X
KY3004429363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000770823OtherANTHEM - NCMA/DUPONT
IN200802220Medicaid
KY000000775339OtherANTHEM - NCMA/BRECKENRIDGE
KY136935OtherSIHO - NCMA BRECKENRIDGE LN
KY78016912Medicaid
KY136933OtherSIHO-NCMA-DUPONT
KY50040433OtherPASSPORT - NCMA DUPONT
KY136933OtherSIHO-NCMA-DUPONT
KY50040433OtherPASSPORT - NCMA DUPONT
KY000000770823OtherANTHEM - NCMA/DUPONT
IN232320NMedicare PIN
KY50040433OtherPASSPORT - NCMA DUPONT
IN200802220Medicaid