Active NPI
Danielle Mack, CHLS
- Prosthetics Case Management
- Louisville, KY
National Provider Identifier
1669974168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetics Case Management
- License
- 208622
- Practice address
- 4611 Peachtree Ave
Louisville, KY 40215-2442 - Phone
- (502) 794-7008
- NPI assigned
- Mar 1, 2018
- 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 |
|---|---|---|---|---|
| Prosthetics Case Management | 1744P3200X | 208622 | KY | Primary |
Addresses
Primary practice location
4611 Peachtree Ave
Louisville, KY 40215-2442
Mailing address
4611 Peachtree Ave
Louisville, KY 40215-2442
Phone (502) 794-7008
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 208622 | KY | MD | Prosthetics Case Management |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1519862400000",
"number": "1669974168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4611 PEACHTREE AVE",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402152442",
"telephone_number": "502-794-7008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4611 PEACHTREE AVE",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402152442",
"telephone_number": "502-794-7008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "DANIELLE",
"credential": "CHLS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-03-01",
"last_updated": "2018-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "1744P3200X",
"taxonomy_group": "",
"desc": "Specialist, Prosthetics Case Management",
"state": "KY",
"license": "208622",
"primary": true
}
],
"identifiers": [],
"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 Mar 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.