Healthcare Provider Details

I. General information

NPI: 1003062357
Provider Name (Legal Business Name): NANCY ELISE KEARNS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CREEKROCK CIR
NICHOLASVILLE KY
40356-8037
US

IV. Provider business mailing address

1639 SILVER PHEASANT CIR
LEXINGTON KY
40511-1374
US

V. Phone/Fax

Practice location:
  • Phone: 859-401-2941
  • Fax: 480-323-2104
Mailing address:
  • Phone: 859-401-2941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004930
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: