Healthcare Provider Details

I. General information

NPI: 1568278554
Provider Name (Legal Business Name): KELSEY HATTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E CHESTNUT ST
LOUISVILLE KY
40202-1713
US

IV. Provider business mailing address

411 E CHESTNUT ST
LOUISVILLE KY
40202-1713
US

V. Phone/Fax

Practice location:
  • Phone: 502-588-3400
  • Fax: 502-588-3401
Mailing address:
  • Phone: 502-588-3400
  • Fax: 502-588-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number1148747
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: