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General NPI Number Information
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NPI Number | 1962638296
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Entity Type | Individual
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Provider Name | KELLY ELISE MCCONATHY ARNP
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Gender | Female
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Dates
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Enumeration Date | 06/01/2009
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Last Update Date | 04/17/2012
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Provider Practice Location Address
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Address Line | 800 ROSE ST
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City | LEXINGTON
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State | KY
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Zip | 40536-0001
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Country | US
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Telephone | 859-323-5956
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Fax | 859-323-1080
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Provider Business Mailing Address
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Address Line | 2333 ALUMNI PARK PLZ SUITE 200
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City | LEXINGTON
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State | KY
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Zip | 40517-4012
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Country | US
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Telephone | 859-257-7910
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Fax | 859-257-7987
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4195P
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 4195P
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License Number State | KY
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