Trace Kelly, FNP-C, DC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

3015925 Issued in KY

Practice address

4613 Roxann Blvd Ste 101
Louisville, KY 40218-4072

Phone

(502) 415-3943

Fax

(502) 451-5041

NPI assigned

Apr 23, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KY2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JJGAED/Endpoint/JJGAED

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.

• Primary Express Care and Wellness LLC

  • Family Nurse Practitioner
  • Louisville, KY
  • NPI 1548115025
  NPD Authorized official
• Primary Injury Consulting, LLC

  • Family Nurse Practitioner
  • Louisville, KY
  • NPI 1003770611
  NPD Authorized official
• Michael Grass

  • Chiropractor
  • Louisville, KY
  • NPI 1861520298
  NPD (past)
• Valley Station Chiropractic & Rehab,PLLC

  • Chiropractor
  • Louisville, KY
  • NPI 1316280688
  NPD (past)
• Todd Allen Camarata DC

  • Orthopedic Chiropractor
  • Sterling Heights, MI
  • NPI 1891989869
  NPD (past)

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625616000000",
    "number": "1629296603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4227 POPLAR LEVEL RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402131527",
            "telephone_number": "502-451-5959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4613 ROXANN BLVD STE 101",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402184072",
            "telephone_number": "502-415-3943",
            "fax_number": "502-451-5041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "TRACE",
        "name_prefix": "Dr.",
        "credential": "FNP-C, DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-23",
        "last_updated": "2021-07-07",
        "certification_date": "2021-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "KY",
            "license": "4973",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3015925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela Kelly
• Patrick Anthony Kelly, DDS
• Robert Douglas Kelly, MD
• Sean Michael Kelly, LPCC
• Thomas John Kelly, M.D.
• Chrystal Leanette Kelmanson, APRN
• Deborah Kelsey
• Larry Kelsey, RPH
• Samantha Kelsey
• Steven Maurice Kelsey, PH.D; M.ED, LPCC

• Family Nurse Practitioner in Louisville, KY
• Providers in Louisville, KY by specialty
• Family Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.