Healthcare Provider Details

I. General information

NPI: 1457662215
Provider Name (Legal Business Name): KAYLAE B WHISMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2010
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MEDICAL VILLAGE DRIVE SUITE 200 B
EDGEWOOD KY
41017-5406
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-8686
  • Fax: 859-301-8690
Mailing address:
  • Phone: 859-341-3383
  • Fax: 859-578-2013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3006112
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3006112
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: