Provider Demographics
NPI:1821415399
Name:HOLMES, KELSEY LOVE (APRN)
Entity type:Individual
Prefix:MISS
First Name:KELSEY
Middle Name:LOVE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1930 BISHOP LN
Mailing Address - Street 2:SUITE 1017
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1921
Mailing Address - Country:US
Mailing Address - Phone:502-272-5754
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:676 S FLOYD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1840
Practice Address - Country:US
Practice Address - Phone:502-629-4440
Practice Address - Fax:502-629-4599
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201242750Medicaid
KY3008292OtherLICENSE
KY7100300570Medicaid
KYK128810Medicare PIN