Provider Demographics
NPI:1033583448
Name:DILL, MISTY NICOLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:NICOLE
Last Name:DILL
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 S 4TH ST STE 700
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3046
Mailing Address - Country:US
Mailing Address - Phone:502-804-5495
Mailing Address - Fax:833-563-1715
Practice Address - Street 1:312 S 4TH ST STE 700
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3046
Practice Address - Country:US
Practice Address - Phone:502-804-5495
Practice Address - Fax:833-563-1715
Is Sole Proprietor?:No
Enumeration Date:2015-11-23
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009838363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100389770Medicaid
13660487OtherCAQH