Healthcare Provider Details

I. General information

NPI: 1912523242
Provider Name (Legal Business Name): KELLI KOORS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 MADISON AVE
COVINGTON KY
41011-1505
US

IV. Provider business mailing address

503 FARRELL DR
COVINGTON KY
41011-3775
US

V. Phone/Fax

Practice location:
  • Phone: 859-578-3200
  • Fax: 859-534-2627
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3014647
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: