Provider Demographics
NPI:1962099390
Name:NOVITSKY, YLLENA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:YLLENA
Middle Name:MARIE
Last Name:NOVITSKY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:YLLENA
Other - Middle Name:MARIE
Other - Last Name:POPOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 HOMEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-1366
Mailing Address - Country:US
Mailing Address - Phone:502-648-5514
Mailing Address - Fax:
Practice Address - Street 1:4612 CHAMBERLAIN LN # 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-1071
Practice Address - Country:US
Practice Address - Phone:502-996-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1159096163W00000X
KY3014120363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily