MEDICARE: MARY KATHLEEN NELMS 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	363LP0200X	Pediatric Nurse Practitioner	3008015	KY

General Provider Information

NPI Number	:	1922441427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KATHLEEN NELMS APRN

Provider Business Mailing Address
First Line	:	1945 HIGHLAND PIKE
Second Line	:	SUITE 1
City	:	FT WRIGHT
State	:	KY
Zip	:	41017-8127
Country	:	US
Telephone Number	:	859-331-4005
Fax Number	:	859-331-4606

Provider Business Practice Location Address
First Line	:	1945 HIGHLAND PIKE
Second Line	:	SUITE 1
City	:	FT WRIGHT
State	:	KY
Zip	:	41017-8127
Country	:	US
Telephone Number	:	859-331-4005
Fax Number	:	859-331-4606

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

Provider Enumeration Date	:	04/15/2013
Last Update Date	:	04/15/2013

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