Individual provider Active NPI

Martha June Kloss, ARNP

  • Family Nurse Practitioner
  • Paducah, KY
National Provider Identifier
1629030465
Registry record updated Oct 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
ARNP 3987P Issued in KY
Practice address
225 Medical Center Dr
Ste. 304
Paducah, KY 42003-7914
Phone
(270) 441-4301
Fax
(270) 441-4739
NPI assigned
Apr 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X ARNP 3987P KY Primary

Addresses

Primary practice location

225 Medical Center Dr
Ste. 304
Paducah, KY 42003-7914

Mailing address

225 Medical Center Dr
Ste. 304
Paducah, KY 42003-7914
Phone (270) 441-4301

Other identifiers 1

IdentifierTypeStateIssuer
78010808MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ARNP 3987PKYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Ophthalmology Group, LLC CurrentSince Aug 1, 2016 Accepting new patients
Purchase Derm-ENT, PLLC Family Past Accepting new patients

Locations

4630 Village Square Dr
Ste 102
Paducah, KY 42001
Phone (270) 443-4393

4630 Village Square Dr
Paducah, KY 42001
Phone (270) 442-1671

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192579200000",
    "number": "1629030465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 MEDICAL CENTER DR",
            "address_2": "STE. 304",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420037914",
            "telephone_number": "270-441-4301",
            "fax_number": "270-441-4739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 MEDICAL CENTER DR",
            "address_2": "STE. 304",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420037914",
            "telephone_number": "270-441-4301",
            "fax_number": "270-441-4739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLOSS",
        "first_name": "MARTHA",
        "middle_name": "JUNE",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-05",
        "last_updated": "2007-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "ARNP 3987P",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78010808",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paducah, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; 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.