NPIMap

Individual provider Active NPI

Kelly Mike, NP

  • Adult Health Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1073939468
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
APN3008550 Issued in KY
Practice address
1731 Dixie Hwy
Louisville, KY 40210-2313
Phone
(502) 444-6016
NPI assigned
Mar 10, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 3008550 KY
Adult Health Nurse Practitioner 363LA2200X APN3008550 KY Primary

Addresses

Primary practice location

1731 Dixie Hwy
Louisville, KY 40210-2313

Mailing address

PO Box 740017
Atlanta, GA 30374-0017
Phone (312) 733-0373

Other practice location 1

12201 Bluegrass Pkwy
Louisville, KY 40299-2361
Phone (502) 568-7366

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140409001229 KY Practitioner - Nurse Practitioner 9638301419 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Vanderbilt University School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vitae Health Medical Kentucky, LLCGroup PAC ID 3173952637, 28 clinicians

Practice addresses (Care Compare)

1700 Old Lebanon Rd
Campbellsville, KY 42718-9662
Phone (270) 789-6116

3500 Good Samaritan Way
Louisville, KY 40299-6117
Phone (502) 267-7403

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APN3008550KYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Oak Street Health Physicians Group of Kentucky, PLLC CurrentSince Apr 29, 2024 Accepting new patients
Nova Physician Group PLLC CurrentSince Aug 11, 2024 Accepting new patients
Hepatitis C Treatment Centers Inc CurrentSince Oct 1, 2024 Accepting new patients
Taylor Regional Medical Group,LLC Current Accepting new patients
Commonhealth LLC CurrentSince May 10, 2023 Accepting new patients
Hepatitis C Treatment Centers Inc CurrentSince Oct 1, 2024 Accepting new patients
Taylor Regional Medical Group Adult Health CurrentSince Nov 12, 2024 Accepting new patients
Faith Healthcare Inc CurrentSince Dec 15, 2024 Accepting new patients
Telos Health Systems Ky LLC CurrentSince Aug 1, 2025 Accepting new patients
Taylor Regional Medical Group LLC CurrentSince Nov 12, 2024 Accepting new patients
Faith Healthcare Inc CurrentSince Dec 15, 2024 Accepting new patients
Commonhealth LLC PastSince May 10, 2023 Accepting new patients
Taylor Regional Medical Group Past Accepting new patients
Oak Street Health Physicians Group of South Carolina, LLC Past Accepting new patients

Locations

1700 Old Lebanon Rd
Campbellsvlle, KY 42718
Phone (270) 465-3561

1698 Old Lebanon Rd
Campbellsvlle, KY 42718
Phone (270) 465-3561

1121 Louisville Rd
Ste 501
Frankfort, KY 40601
Phone (502) 661-1444

1009A N DuPont Sq
Louisville, KY 40207
Phone (502) 894-9950

1731 Dixie Hwy
Louisville, KY 40210
Phone (502) 444-6016

3500 Good Samaritan Way
Louisville, KY 40299
Phone (502) 267-7403

5743 Preston Hwy
Louisville, KY 40219
Phone (502) 444-6008

126 Franklin Rd
Monticello, KY 42633
Phone (606) 396-3534

9919 W Highway 80
Nancy, KY 42544
Phone (606) 288-0019

1333 W Main St
Princeton, KY 42445
Phone (270) 365-3541

5775 N Highway 27
Ste 6
Science Hill, KY 42553
Phone (606) 489-3629

Organizations & group practices 16

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 16

Hospital & facility affiliations 39

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 39

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1394409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722988800000",
    "number": "1073939468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 740017",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303740017",
            "telephone_number": "312-733-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1731 DIXIE HWY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402102313",
            "telephone_number": "502-444-6016"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12201 Bluegrass Pkwy",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402992361",
            "country_code": "US",
            "telephone_number": "502-568-7366",
            "fax_number": "502-568-7114",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIKE",
        "first_name": "KELLY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-10",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "KY",
            "license": "3008550",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "KY",
            "license": "APN3008550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.