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NPI Code Detail

MEDICARE: MS. KELLY M JOY PA-C

MEDICARE: MS. KELLY M JOY PA-C
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
1363AS0400XSurgical Physician AssistantPA1638KY
2363A00000XPhysician AssistantPA-1638KY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01621467OTHERKYRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2000000751974OTHERKYANTHEM - WS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144554957
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KELLY M JOY PA-C
Provider Business Mailing Address
First Line : PO BOX 776351
Second Line :
City : CHICAGO
State : IL
Zip : 60677-6351
Country : US
Telephone Number : 502-588-9490
Fax Number : 502-272-5116
Provider Business Practice Location Address
First Line : 4123 DUTCHMANS LN STE 607
Second Line :
City : LOUISVILLE
State : KY
Zip : 40207-4725
Country : US
Telephone Number : 502-899-6470
Fax Number : 502-899-6479
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2009
Last Update Date : 04/24/2024

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Directions to “ MS. KELLY M JOY PA-C” Practice Location

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