Organization
KIOSK MEDICINE KENTUCKY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS SHELLY (VP & GENERAL MANAGER)
(615) 425-4200
Entity
Organization
Contact information
Practice address
4915 DIXIE HWY, LOUISVILLE, KY 40216-2501
(502) 449-8608
(502) 449-8609
Mailing address
PO BOX 932958, CLEVELAND, OH 44193-0028
(615) 425-4200
(615) 425-4201
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100276200
—
KY
Enumeration date
10/04/2016
Last updated
10/21/2025
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