Healthcare Provider Details

I. General information

NPI: 1578357794
Provider Name (Legal Business Name): NKY WELLNESS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7310 TURFWAY RD STE 550
FLORENCE KY
41042-4872
US

IV. Provider business mailing address

10441 BROOKHURST LN N
UNION KY
41091-3401
US

V. Phone/Fax

Practice location:
  • Phone: 859-203-5963
  • Fax:
Mailing address:
  • Phone: 859-907-5816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ASHLEIGH EVERSOLE
Title or Position: OWNER
Credential: APRN
Phone: 859-907-5816