Individual
MS. KELLY M JOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4123 DUTCHMANS LN STE 607, LOUISVILLE, KY 40207-4725
(502) 899-6470
(502) 899-6479
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1638
KY
363AS0400X
Surgical Physician Assistant
PA1638
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000751974
ANTHEM - WS
KY
05
—
7100174740
—
KY
01
—
P01621467
RR MEDICARE
KY
Enumeration date
09/25/2009
Last updated
04/24/2024
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