Active NPI
Casey Nicole Prestigiacomo, APRN
- Family Nurse Practitioner
- Shepherdsville, KY
National Provider Identifier
1154934743
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 3015000
- Practice address
- 189 Adam Shepherd Pkwy Ste 14
Shepherdsville, KY 40165-6579 - Phone
- (502) 531-9823
- NPI assigned
- Aug 25, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 3015000 | KY | |
| Family Nurse Practitioner | 363LF0000X | 3015000 | KY | Primary |
Addresses
Primary practice location
189 Adam Shepherd Pkwy Ste 14
Shepherdsville, KY 40165-6579
Mailing address
189 Adam Shepherd Pkwy Ste 14
Shepherdsville, KY 40165-6579
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1951718949 | Medicaid | KY |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Info@bluminehealth.com | Other |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 12, 2024 through Nov 12, 2026
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": "1598313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651536000000",
"number": "1154934743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "189 ADAM SHEPHERD PKWY STE 14",
"city": "SHEPHERDSVILLE",
"state": "KY",
"postal_code": "401656579"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "189 ADAM SHEPHERD PKWY STE 14",
"city": "SHEPHERDSVILLE",
"state": "KY",
"postal_code": "401656579",
"telephone_number": "502-531-9823"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRESTIGIACOMO",
"first_name": "CASEY",
"middle_name": "NICOLE",
"name_prefix": "Mrs.",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-25",
"last_updated": "2022-05-03",
"certification_date": "2021-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "KY",
"license": "3015000",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "KY",
"license": "3015000",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1951718949",
"state": "KY"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Info@bluminehealth.com",
"affiliation": "N",
"endpointDescription": "Company email",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "Information",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "189 Adam Shepherd Pkwy Ste 14",
"city": "Shepherdsville",
"state": "KY",
"country_code": "US",
"postal_code": "401656579",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Shepherdsville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.