Individual provider Active NPI

Tiffany Ramirez-Icaza, APRN

  • Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1801294731
Registry record updated May 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
3008983 Issued in KY
Practice address
716 W Broadway
Louisville, KY 40202-2216
Phone
(502) 595-7744
NPI assigned
Dec 9, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 3008983 KY Primary

Addresses

Primary practice location

716 W Broadway
Louisville, KY 40202-2216

Mailing address

PO Box 776351
Chicago, IL 60677-6351
Phone (502) 588-9490

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150413002451 KY Practitioner - Nurse Practitioner 6507184090 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
3008983KYMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kidney Care Consultants, PSC Nurse Practitioner CurrentSince May 25, 2021 Accepting new patients

Locations

716 W Broadway
Louisville, KY 40202
Phone (502) 222-3449

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1418083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621814400000",
    "number": "1801294731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776351",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776351",
            "telephone_number": "502-588-9490",
            "fax_number": "502-272-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 W BROADWAY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402022216",
            "telephone_number": "502-595-7744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAMIREZ-ICAZA",
        "first_name": "TIFFANY",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-09",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3008983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.