Provider Demographics
NPI:1518566553
Name:JOELSON, KENLEY N
Entity Type:Individual
Prefix:
First Name:KENLEY
Middle Name:N
Last Name:JOELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S 4TH ST UNIT 710
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-1526
Mailing Address - Country:US
Mailing Address - Phone:678-463-7857
Mailing Address - Fax:
Practice Address - Street 1:2400 S 4TH ST UNIT 710
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-1526
Practice Address - Country:US
Practice Address - Phone:678-463-7857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty