Provider Demographics
NPI:1922441427
Name:NELMS, MARY KATHLEEN (APRN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHLEEN
Last Name:NELMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1945 HIGHLAND PIKE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41017-8127
Mailing Address - Country:US
Mailing Address - Phone:859-331-4005
Mailing Address - Fax:859-331-4606
Practice Address - Street 1:1945 HIGHLAND PIKE
Practice Address - Street 2:SUITE 1
Practice Address - City:FT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41017-8127
Practice Address - Country:US
Practice Address - Phone:859-331-4005
Practice Address - Fax:859-331-4606
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3008015363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics