Healthcare Provider Details

I. General information

NPI: 1285026476
Provider Name (Legal Business Name): KELLY THUENEMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 THOMAS MORE PKWY STE A
CRESTVIEW HILLS KY
41017-3498
US

IV. Provider business mailing address

215 THOMAS MORE PKWY STE A
CRESTVIEW HILLS KY
41017-3498
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-9588
  • Fax: 859-341-0078
Mailing address:
  • Phone: 859-341-9588
  • Fax: 859-341-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3010234
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: