Healthcare Provider Details

I. General information

NPI: 1346674884
Provider Name (Legal Business Name): KATELIN H ELM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2013
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8442 DIXIE HWY
LOUISVILLE KY
40258
US

IV. Provider business mailing address

8442 DIXIE HWY
LOUISVILLE KY
40258
US

V. Phone/Fax

Practice location:
  • Phone: 502-638-4280
  • Fax: 502-638-4281
Mailing address:
  • Phone: 502-638-4280
  • Fax: 502-638-4281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3008264
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: