Individual
KELLY MIKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1731 DIXIE HWY, LOUISVILLE, KY 40210-2313
(502) 444-6016
Mailing address
PO BOX 740017, ATLANTA, GA 30374-0017
(312) 733-0373
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
APN3008550
KY
363LG0600X
Gerontology Nurse Practitioner
3008550
KY
Other
Enumeration date
03/10/2014
Last updated
08/07/2024
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