# NEUROSCIENCE ASSOCIATES OF NORTHERN KENTUCKY PSC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215936240
- **Authorized official:** JOHN B KELLY MD (PRESIDENT)
- **Authorized official phone:** (859) 341-3412

## Contact information

- **Practice address:** 2845 CHANCELLOR DR, CRESTVIEW HILLS, KY 41017-3452
- **Practice address phone:** (859) 341-3412
- **Practice address fax:** (859) 341-3171
- **Mailing address:** 2845 CHANCELLOR DR, CRESTVIEW HILLS, KY 41017-3418
- **Mailing address phone:** (859) 341-3412
- **Mailing address fax:** (859) 341-3171

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | 1096049 | KY | Yes |

## Other

- **Enumeration date:** 07/20/2005
- **Last updated:** 01/06/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 6081204000 | DOL | KY |
| 05 | — | 65933947 | — | KY |
| 01 | — | DF1983 | RAILROAD MEDICARE | KY |