Provider Demographics
NPI:1649566605
Name:LOWN, KELLY KAYE (MSN, APRN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:KAYE
Last Name:LOWN
Suffix:
Gender:F
Credentials:MSN, APRN
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 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-655-4111
Mailing Address - Fax:859-655-4815
Practice Address - Street 1:1500 JAMES SIMPSON JR WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-0801
Practice Address - Country:US
Practice Address - Phone:859-655-4111
Practice Address - Fax:859-655-4815
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006975363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100182000Medicaid
KYP01010094OtherRAILROAD MEDICARE
OH0059482Medicaid
KYK013701Medicare PIN