MEDICARE: KALYN NICOLE CHURCHILL APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	3017857	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114658911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALYN NICOLE CHURCHILL APRN

Provider Business Mailing Address
First Line	:	PO BOX 776351
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6351
Country	:	US
Telephone Number	:	502-559-9407
Fax Number	:	502-272-5339

Provider Business Practice Location Address
First Line	:	12615 TAYLORSVILLE RD STE A
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-4452
Country	:	US
Telephone Number	:	502-261-1595
Fax Number	:	502-261-1590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2022
Last Update Date	:	06/04/2026

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