Individual
KELLI JO MARRILLIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
9080 TAYLORSVILLE RD, LOUISVILLE, KY 40299-1750
(502) 499-9998
Mailing address
9080 TAYLORSVILLE RD, LOUISVILLE, KY 40299-1750
(502) 499-9998
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3011794
KY
363LF0000X
Family Nurse Practitioner
70104593A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1136581
STATE LICENSE
KY
01
—
71014593A
STATE LICENSE
IN
Enumeration date
04/12/2018
Last updated
03/26/2024
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