Kathleen Ann Dively, ARNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

2743P Issued in KY

Practice address

800 Zorn Ave
Louisville, KY 40206-1433

Phone

(502) 227-2285

Fax

(502) 227-1465

NPI assigned

May 1, 2006

Last updated

Aug 17, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Primary Care of the Bluegrass, LLC

  dba Crab Orchard Primary Care

  • Primary Care Clinic/Center
  • Crab Orchard, KY
  • NPI 1942463096

  Nurse Practitioner

  NPD
• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  Nurse Practitioner

  NPD

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629158400000",
    "number": "1639137763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 ZORN AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402061433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 ZORN AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402061433",
            "telephone_number": "502-227-2285",
            "fax_number": "502-227-1465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIVELY",
        "first_name": "KATHLEEN",
        "middle_name": "ANN",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-01",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "2743P",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64314107",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100029980",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher Distler, DPT
• Dana J Distler, M.D.
• Distler, Huntington & Blair PSC (Bluegrass Eye Center)
• Mark W Distler, M.D.
• Walter David Distler, DMD
• Diversicare Highlands, LLC (Highlands Health and Rehabilitation Center)
• Diversicare of Seneca Place LLC (Diversicare of Seneca Place)
• Diversified Patient Resources, Inc.
• Divine Care
• Divine Residential Care Services

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

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