Provider Demographics
NPI:1174803050
Name:LOERKE, TIMOTHY J (PA-C)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:J
Last Name:LOERKE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3061
Mailing Address - Country:US
Mailing Address - Phone:865-293-5335
Mailing Address - Fax:
Practice Address - Street 1:13151 MAGISTERIAL DR STE 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4103
Practice Address - Country:US
Practice Address - Phone:502-587-1236
Practice Address - Fax:502-587-0126
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1785363A00000X
IN10002494A363A00000X
TXPA07315363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA07315OtherTEXAS STATE LICENSE
KYPA1785OtherKENTUCKY STATE LICENSE
TX1098783OtherNCCPA
TX288231801Medicaid
TXPA07315OtherTEXAS STATE LICENSE