Individual
KATHLEEN ANN DIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
800 ZORN AVE, LOUISVILLE, KY 40206-1433
(502) 227-2285
(502) 227-1465
Mailing address
800 ZORN AVE, LOUISVILLE, KY 40206-1433
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2743P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64314107
—
KY
05
—
7100029980
—
KY
Enumeration date
05/01/2006
Last updated
08/17/2021
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