PARK DUVALLE COMMUNITY HEALTH CENTER, INC.
NPI 1245253160
Clinic/Center - Federally Qualified Health Center (FQHC) in Louisville, KY

Q: What is Park Duvalle Community Health Center, Inc.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Active since July 25, 2006CLIA 18D0321510 · Certificate of Compliance

3015 WILSON AVE, LOUISVILLE, KY 40211(502) 774-4401(502) 772-4783 Get Directions Write a Review

NPPES record last updated: November 2, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Nov 2, 2021, Dec 19, 2016 (2 updates tracked since 2016).

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About Park Duvalle Community Health Center, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PARK DUVALLE COMMUNITY HEALTH CENTER, INC. (NPI 1245253160) is a healthcare organization registered as a federally qualified health center (fqhc) in Louisville, Kentucky and active in the NPI registry since July 2006. The organization holds a CLIA Certificate of Compliance certificate valid through November 9, 2027 and lists Swannie Jett, Ceo, as its authorized official.

NPPES Registry Identity

NPI1245253160

Entity TypeOrganization

Primary Taxonomy261QF0400X

Legal Business NamePARK DUVALLE COMMUNITY HEALTH CENTER, INC.

Location Address3015 WILSON AVELouisville, KY 40211-1969

Mailing Address3015 Wilson AveLouisville, KY 40211-1969 · (502) 774-4401 · Fax (502) 772-4783

Phone(502) 774-4401

Fax(502) 772-4783

Organization SubpartNo

Authorized OfficialSwannie JettCeo · (502) 774-4401

Enumeration DateJuly 25, 2006

Last NPPES UpdateNovember 2, 20212 updates tracked since enumeration

NPPES CertifiedNovember 2, 2021

✔ NPI 1245253160 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities

Taxonomy Code261QF0400X

License✔ Licensed in KY · 700005

3015 WILSON AVE, Louisville, KY 40211

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Other Identifiers 1

Medicaid31000011KY

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Home State Health, Ambetter Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 18D0321510

Park Duvalle Community Health Ctr · Louisville, KY

Active · expires Nov 9, 2027

CLIA Number18D0321510

Laboratory TypeCommunity Clinic

Certificate Effective DateNovember 10, 2025

Certificate Expiration DateNovember 9, 2027

Laboratory DirectorDr. Mohammad A. Faghri

Laboratory Phone(502) 774-4401

Laboratory LocationPark Duvalle Community Health Ctr3015 Wilson Ave, Louisville, KY 40211

CLIA data matches this NPI record on: Address Phone

This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NIKEEA BULLOCK APRN

Nurse Practitioner (Psychiatric/Mental Health)