Basic Information
| Provider Information | |||||||||
| NPI: | 1265106777 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROWE | ||||||||
| FirstName: | KELLIE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3048 TOWN BRANCH RD | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405118835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376207764 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1740 NICHOLASVILLE RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405031431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592606100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2021 | ||||||||
| LastUpdateDate: | 08/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3013636 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.