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General NPI Number Information
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NPI Number | 1972989267
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Entity Type | Individual
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Provider Name | STACEY L KELLEY FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/10/2015
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Last Update Date | 01/19/2021
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Provider Practice Location Address
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Address Line | 3 AUDUBON PLAZA DR STE 560
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City | LOUISVILLE
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State | KY
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Zip | 40217-1300
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Country | US
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Telephone | 502-567-2628
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5116
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3009353
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License Number State | KY
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