Healthcare Provider Details

I. General information

NPI: 1275569311
Provider Name (Legal Business Name): MOLLY MCELFRESH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 LANDMARK DR
BELLEVUE KY
41073-1393
US

IV. Provider business mailing address

3200 VINE ST VA MEDICAL CENTER, PRIMARY CARE
CINCINNATI OH
45220-2213
US

V. Phone/Fax

Practice location:
  • Phone: 859-392-3846
  • Fax: 859-392-3841
Mailing address:
  • Phone: 859-392-3846
  • Fax: 859-392-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3958P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: