Organization
NEUROSCIENCE ASSOCIATES OF NORTHERN KENTUCKY PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN B KELLY MD (PRESIDENT)
(859) 341-3412
Entity
Organization
Contact information
Practice address
2845 CHANCELLOR DR, CRESTVIEW HILLS, KY 41017-3452
(859) 341-3412
(859) 341-3171
Mailing address
2845 CHANCELLOR DR, CRESTVIEW HILLS, KY 41017-3418
(859) 341-3412
(859) 341-3171
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
1096049
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6081204000
DOL
KY
05
—
65933947
—
KY
01
—
DF1983
RAILROAD MEDICARE
KY
Enumeration date
07/20/2005
Last updated
01/06/2011
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