Provider Demographics
NPI:1821549585
Name:SHEEHY, KELLIE (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:SHEEHY
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9503 NORTON COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-7522
Mailing Address - Country:US
Mailing Address - Phone:502-767-8224
Mailing Address - Fax:
Practice Address - Street 1:9503 NORTON COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-7522
Practice Address - Country:US
Practice Address - Phone:502-767-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010776363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily