Provider Demographics
NPI:1477719987
Name:EASTON, KELLEY R (MSN, FNP-BC, NP-C)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:R
Last Name:EASTON
Suffix:
Gender:F
Credentials:MSN, FNP-BC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:189 OUTER LOOP
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-5544
Practice Address - Country:US
Practice Address - Phone:502-363-1731
Practice Address - Fax:502-364-9272
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004175363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily