NPIMap

Organization Active NPI

Neuroscience Associates of Northern Kentucky PSC

  • Primary Care Nurse Practitioner
  • Crestview Hills, KY
National Provider Identifier
1215936240
Registry record updated Jan 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
1096049 Issued in KY
Legal business name
NEUROSCIENCE ASSOCIATES OF NORTHERN KENTUCKY PSC
Practice address
2845 Chancellor Dr
Crestview Hills, KY 41017-3452
Phone
(859) 341-3412
Fax
(859) 341-3171
NPI assigned
Jul 20, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2011

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

Authorized official

Name
John B Kelly, MDNPI 1407855315
Title
President
Phone
(859) 341-3412

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X 1096049 KY Primary

Addresses

Primary practice location

2845 Chancellor Dr
Crestview Hills, KY 41017-3452

Mailing address

2845 Chancellor Dr
Crestview Hills, KY 41017-3418
Phone (859) 341-3412

Other identifiers 3

IdentifierTypeStateIssuer
65933947MedicaidKY
6081204000OtherKYDOL
DF1983OtherKYRAILROAD MEDICARE

National Provider Directory

National Provider Directory
Tax ID family
Neuroscience Associates of Northern Kentucky PSC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294272000000",
    "number": "1215936240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2845 CHANCELLOR DR",
            "city": "CRESTVIEW HILLS",
            "state": "KY",
            "postal_code": "410173418",
            "telephone_number": "859-341-3412",
            "fax_number": "859-341-3171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 CHANCELLOR DR",
            "city": "CRESTVIEW HILLS",
            "state": "KY",
            "postal_code": "410173452",
            "telephone_number": "859-341-3412",
            "fax_number": "859-341-3171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROSCIENCE ASSOCIATES OF NORTHERN KENTUCKY PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-20",
        "last_updated": "2011-01-06",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "859-341-3412",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "KY",
            "license": "1096049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65933947",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOL",
            "identifier": "6081204000",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DF1983",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestview Hills, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.