Individual
KELLYE L TAPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
200 CLINIC DR, MADISONVILLE, KY 42431-1661
(270) 825-7200
Mailing address
200 CLINIC DR, MADISONVILLE, KY 42431-1661
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4080P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000314656
BCBS PROVIDER NUMBER
—
01
—
4080P
MEDICAL LICENSE
KY
05
—
78010675
—
KY
01
—
P00047148
MEDICARE RAILROAD PIN
—
Enumeration date
06/02/2006
Last updated
03/07/2023
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