Provider Demographics
NPI:1114157948
Name:CREMEANS, KELLI S (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:S
Last Name:CREMEANS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5200 COMMERCE CROSSING
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2182
Mailing Address - Country:US
Mailing Address - Phone:502-253-4900
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:1760 NICHOLASVILLE RD STE 204
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1472
Practice Address - Country:US
Practice Address - Phone:859-260-2179
Practice Address - Fax:859-260-6234
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3006123363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100085230Medicaid
KY0952509Medicare PIN