NPIMap

Organization Active NPI

Kiosk Medicine of Kentucky LLC

  • Family Nurse Practitioner
  • Danville, KY
National Provider Identifier
1295128502
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 OF KENTUCKY LLC
Practice address
200 Skywatch Dr
Danville, KY 40422-2540
Phone
(859) 936-5630
Fax
(859) 936-5631
NPI assigned
Mar 11, 2015
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

200 Skywatch Dr
Danville, KY 40422-2540

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
7100386380MedicaidKY

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

Locations

200 Skywatch Dr
Danville, KY 40422
Phone (859) 236-0408

NPI Registry JSON

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

{
    "created_epoch": "1426032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761004800000",
    "number": "1295128502",
    "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": "200 SKYWATCH DR",
            "city": "DANVILLE",
            "state": "KY",
            "postal_code": "404222540",
            "telephone_number": "859-936-5630",
            "fax_number": "859-936-5631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIOSK MEDICINE OF KENTUCKY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-11",
        "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": "7100386380",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Danville, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.