| Mandran Health Pllc | |
|
4010 Dupont Cir Ste 411 Louisville KY 40207-4837 | |
| (502) 275-0035 | |
| (502) 275-0034 |
| Full Name | Mandran Health Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4010 Dupont Cir Ste 411, Louisville, Kentucky |
| Authorized Official Name and Position | Samantha H Wilson (DIRECTOR) |
| Authorized Official Contact | 5022750035 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mandran Health Pllc 4010 Dupont Cir Ste 411 Louisville KY 40207-4837 Ph: (502) 275-0035 | Mandran Health Pllc 4010 Dupont Cir Ste 411 Louisville KY 40207-4837 Ph: (502) 275-0035 |
| NPI Number | 1205281862 |
|---|---|
| Provider Enumeration Date | 05/02/2016 |
| Last Update Date | 09/10/2021 |
| Certification Date | 09/10/2021 |
| Medicare PECOS PAC ID | 1254624588 |
|---|---|
| Medicare Enrollment ID | O20160725002579 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205281862 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Donna Latham Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881605442 PECOS PAC ID: 8123047644 Enrollment ID: I20051114001207 |
| Provider Name | Sherri L Bunch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922195445 PECOS PAC ID: 7719073881 Enrollment ID: I20071020000021 |
| Provider Name | Manoj Chandran |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629281761 PECOS PAC ID: 7113068933 Enrollment ID: I20091230000519 |
| Provider Name | Tricia R Metcalf |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063756088 PECOS PAC ID: 3971814906 Enrollment ID: I20150617003023 |
| Provider Name | Erin Fulkerson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629272877 PECOS PAC ID: 0749579936 Enrollment ID: I20170719003122 |
| Provider Name | Geoffrey L Elmore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861957979 PECOS PAC ID: 3274959127 Enrollment ID: I20200821002406 |
| Provider Name | Viktor A Yatsynovich |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730323239 PECOS PAC ID: 4486970266 Enrollment ID: I20210122001674 |
| Provider Name | Caryn Addonizio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396988358 PECOS PAC ID: 3678621117 Enrollment ID: I20210203001337 |
| Provider Name | Kurt Kristiansen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104387752 PECOS PAC ID: 3577894583 Enrollment ID: I20210402000866 |
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