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General NPI Number Information
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NPI Number | 1568910909
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Entity Type | Organization
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Legal Business Name | KIOSK MEDICINE KENTUCKY LLC
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 90 STONEGATE CTR
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City | SOMERSET
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State | KY
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Zip | 42501-6212
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Country | US
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Telephone | 606-451-4425
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Fax | 606-451-4426
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Provider Business Mailing Address
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Address Line | 1014 VINE ST
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City | CINCINNATI
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State | OH
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Zip | 45202-1141
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Country | US
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Telephone | 615-425-4200
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Fax | 615-425-4201
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Authorized Official
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Title or Position | VP & GENERAL MANAGER
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Name | MR. THOMAS SHELLY
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Credential |
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Telephone | 615-425-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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