NPIMap

Organization Active NPI

Kiosk Medicine Kentucky LLC

  • Family Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1205885035
Registry record updated Oct 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
KIOSK MEDICINE KENTUCKY LLC
Practice address
3039 Breckenridge LN
Louisville, KY 40220-2101
Phone
(502) 451-4555
Fax
(502) 451-0884
NPI assigned
May 9, 2006
Last updated
Oct 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2025

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

Authorized official

Name
Mr. Thomas Shelly
Title
VP & General Manager
Phone
(615) 425-4200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Family Nurse Practitioner 363LF0000X NU Primary

Addresses

Primary practice location

3039 Breckenridge LN
Louisville, KY 40220-2101

Mailing address

PO Box 932958
Cleveland, OH 44193-0028
Phone (615) 425-4200

Other identifiers 1

IdentifierTypeStateIssuer
7100276100MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040805001127 KY Part B Supplier - Clinic/Group Practice 6002887510 Receives reassigned benefits from 484 practitioners
Practice locations: Louisville, KY; Middletown, KY; Mount Washington, KY; Newport, KY; Prospect, KY; Richmond, KY; Shelbyville, KY; Shepherdsville, KY…

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D1015023Kiosk Medicine Kentucky, LLC3039 Breckenridge Lane, Louisville, KY 40220Certificate of waiverJul 21, 2027

National Provider Directory

National Provider Directory
Tax ID family
Kiosk Medicine Kentucky LLC43 organizations share this tax ID, including this one

Other organizations with this tax ID 42

Organizations that report the same tax identification number in the National Provider Directory.

View all 42

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

102 W John Rowan Blvd
Bardstown, KY 40004
Phone (502) 348-3062

2945 Scottsville Rd
Ste E32
Bowling Green, KY 42104
Phone (270) 783-3992

2150 Dixie Hwy
Ft Mitchell, KY 41017
Phone (859) 292-1784

1700 Declaration Dr
Independence, KY 41051
Phone (859) 363-9020

2440 Bardstown Rd
Louisville, KY 40205
Phone (502) 459-3248

279 N Hubbards LN
Louisville, KY 40207

279 N Hubbards LN
Louisville, KY 40207
Phone (502) 618-8058

4915 Dixie Hwy
Louisville, KY 40216
Phone (502) 448-8247

9080 Taylorsville Rd
Louisville, KY 40299
Phone (502) 491-8805

9440 Brownsboro Rd
Louisville, KY 40241
Phone (502) 425-8407

12501 Shelbyville Rd
Middletown, KY 40243
Phone (502) 244-7960

311 Boone Station Rd
Shelbyville, KY 40065
Phone (502) 437-8000

212 Kroger Way
Versailles, KY 40383
Phone (859) 297-1072

Practitioners & affiliated clinicians

Practitioners 493

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 493

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761004800000",
    "number": "1205885035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 932958",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441930028",
            "telephone_number": "615-425-4200",
            "fax_number": "615-425-4201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3039 BRECKENRIDGE LN",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402202101",
            "telephone_number": "502-451-4555",
            "fax_number": "502-451-0884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIOSK MEDICINE KENTUCKY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A",
        "authorized_official_last_name": "SHELLY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "VP & GENERAL MANAGER",
        "authorized_official_telephone_number": "615-425-4200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100276100",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.