Healthcare Provider Details

I. General information

NPI: 1659895746
Provider Name (Legal Business Name): KAELYN MICHELE KEITH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9510 ORMSBY STATION RD STE 100
LOUISVILLE KY
40223-4082
US

IV. Provider business mailing address

346 SINGLETON WAYNESBURG RD
EUBANK KY
42567-8593
US

V. Phone/Fax

Practice location:
  • Phone: 502-327-1000
  • Fax:
Mailing address:
  • Phone: 606-271-7631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3011595
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: