Individual
KELLY MCCULLOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8709 WOODED GLEN RD, LOUISVILLE, KY 40220-2949
(502) 836-4386
Mailing address
1700 CARGO CT, LOUISVILLE, KY 40299-1938
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2050329
KY
Other
Enumeration date
12/27/2022
Last updated
12/27/2022
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