Individual
KIMBERLY MICHELE KISEGY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
3991 DUTCHMANS LN, LOUISVILLE, KY 40207-4700
(502) 897-2440
(502) 897-2455
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3005185
KY
363LF0000X
Family Nurse Practitioner
5185P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000770823
ANTHEM - NOTC
KY
01
—
136776
SIHO - NOTC
KY
01
—
50039556
PASSPORT - NOTC
KY
05
—
7100202790
—
KY
Enumeration date
01/09/2008
Last updated
07/28/2016
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