Provider Demographics
NPI:1972540276
Name:TAPP, KELLYE L (APRN)
Entity Type:Individual
Prefix:
First Name:KELLYE
Middle Name:L
Last Name:TAPP
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1661
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 CLINIC DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1661
Practice Address - Country:US
Practice Address - Phone:270-825-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4080P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4080POtherMEDICAL LICENSE
P00047148OtherMEDICARE RAILROAD PIN
KY78010675Medicaid
000000314656OtherBCBS PROVIDER NUMBER
000000314656OtherBCBS PROVIDER NUMBER
MT1557012OtherDEA
0601408Medicare PIN
000000314656OtherBCBS PROVIDER NUMBER
P94585Medicare UPIN
KY0771925Medicare PIN
KY78010675Medicaid
KY4080POtherMEDICAL LICENSE
0735743Medicare PIN