Active NPI
Brieanna Puckett
- Speech-Language Pathologist
- Louisville, KY
National Provider Identifier
1023634383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- Practice address
- 17401 Westbury Dr
Louisville, KY 40245-5483 - Phone
- (336) 707-0090
- NPI assigned
- Jun 23, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | Primary |
Addresses
Primary practice location
17401 Westbury Dr
Louisville, KY 40245-5483
Mailing address
17401 Westbury Dr
Louisville, KY 40245-5483
Phone (336) 707-0090
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 272935 | Other | KY | KENTUCKY BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY LICENCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639612800000",
"number": "1023634383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17401 WESTBURY DR",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402455483",
"telephone_number": "336-707-0090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17401 WESTBURY DR",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402455483",
"telephone_number": "336-707-0090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCKETT",
"first_name": "BRIEANNA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-06-23",
"last_updated": "2021-12-16",
"certification_date": "2021-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KENTUCKY BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY LICENCE",
"identifier": "272935",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.