MEDICARE: BLUE CYPRESS IV AND WELLNESS

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	202D00000X	Integrative Medicine Physician

General Provider Information

NPI Number	:	1619801560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE CYPRESS IV AND WELLNESS

Provider Business Mailing Address
First Line	:	111 N HAMILTON ST STE 1
Second Line	:
City	:	GEORGETOWN
State	:	KY
Zip	:	40324-1709
Country	:	US
Telephone Number	:	502-603-0027
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 N HAMILTON ST STE 1
Second Line	:
City	:	GEORGETOWN
State	:	KY
Zip	:	40324-1709
Country	:	US
Telephone Number	:	502-603-0027
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MECHELLE KELLEY
Credential	:	RN
Telephone Number	:	502-603-0027

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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Directions to “BLUE CYPRESS IV AND WELLNESS ” Practice Location

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