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PARK DUVALLE MOBILE DENTISTRY VAN
NPI 1275151292
Clinic/Center - Federally Qualified Health Center (FQHC) in Louisville, KY

Active since July 07, 2020
3015 WILSON AVE, LOUISVILLE, KY 40211(502) 916-7091 Get Directions Write a Review

NPPES record last updated: November 2, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Nov 2, 2021, Aug 7, 2020, Jul 14, 2020 and 1 more (4 updates tracked since 2020).

About Park Duvalle Mobile Dentistry Van NPPES

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

PARK DUVALLE MOBILE DENTISTRY VAN (NPI 1275151292) is a healthcare organization registered as a federally qualified health center (fqhc) in Louisville, Kentucky and active in the NPI registry since July 2020. The organization lists Swannie Jett, Ceo, as its authorized official.

NPPES Registry Identity

NPI1275151292
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
Phone(502) 916-7091
Organization SubpartYes
Authorized OfficialSwannie JettCeo · (502) 774-4401
Enumeration DateJuly 7, 2020
Last NPPES UpdateNovember 2, 20214 updates tracked since enumeration
NPPES CertifiedNovember 2, 2021
✔ NPI 1275151292 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
3015 WILSON AVE, Louisville, KY 40211
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Other Names 1

Doing Business AsPark Duvalle Mobile Dentistry Van

Other Identifiers 3

Medicaid7100595370KY
Medicaid31000011KY
Medicaid31000920KY

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)
3015 WILSON AVE
LOUISVILLE, KY 40211
Jefferson County (502) 774-4401
SYDNI HAMPRON
Community Health Worker
3015 WILSON AVE
LOUISVILLE, KY 40211
Jefferson County (502) 774-4401
DR. PARANITA SHERARD BRATTON M.D
Family Medicine (Adult Medicine)
3015 WILSON AVE
LOUISVILLE, KY 40211
Jefferson County (502) 774-4401
D'NAI CELESTE OVERSTREET D.M.D.
Dentist (General Practice)
3015 WILSON AVE
LOUISVILLE, KY 40211
Jefferson County (502) 774-4401
CIARA SANDEFUR DMD
Dentist (General Practice)
3015 WILSON AVE
LOUISVILLE, KY 40211
Jefferson County (502) 774-4401
TASHANA FORD APRN
Nurse Practitioner (Family)
3015 WILSON AVE
LOUISVILLE, KY 40211
Jefferson County (502) 774-4401
KIARA FARRIS APRN
Nurse Practitioner (Family)
3015 WILSON AVE
LOUISVILLE, KY 40211
Jefferson County (502) 774-4401
MR. LEON C FIGA RPH
Pharmacist
3015 WILSON AVE
LOUISVILLE, KY 40211
Jefferson County (502) 774-4401

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Park Duvalle Community Health Center, Inc's NPI number?

The NPI number for Park Duvalle Community Health Center, Inc is 1275151292. It was assigned to this organization in the NPPES registry on July 7, 2020. The provider is doing business as Park Duvalle Mobile Dentistry Van.

Where is Park Duvalle Community Health Center, Inc located?

Park Duvalle Community Health Center, Inc is located at 3015 Wilson Ave, Louisville, KY 40211. The listed phone number is (502) 916-7091.

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.

When was this NPI record last updated?

The NPPES record for Park Duvalle Community Health Center, Inc was last updated on November 2, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.