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General NPI Number Information
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NPI Number | 1790220176
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Entity Type | Organization
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Legal Business Name | KIOSK MEDICINE OF KENTUCKY LLC
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Dates
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Enumeration Date | 12/21/2016
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 53 DONNERMEYER DR
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City | BELLEVUE
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State | KY
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Zip | 41073-1394
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Country | US
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Telephone | 859-815-7062
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Fax | 859-815-7063
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Provider Business Mailing Address
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Address Line | PO BOX 932958
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City | CLEVELAND
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State | OH
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Zip | 44193-0028
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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 MANGER
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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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