KELLY A JEDLICKI (NPI# 1528155314) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528155314 |
| Entity Type | Individual |
| Full Name | KELLY A JEDLICKI |
| Credential | ARNP |
| Practice Address |
3015 Wilson Ave Louisville KY 40211-1969 |
| Mailing Address |
3532 Ephraim Mcdowell Dr Louisville KY 40205-3224 |
| Practice Telephone | 5027744401 |
| Practice Fax Number | 5027728983 |
| Mailing Telephone | 5024566200 |
| Mailing Fax Number | 5024566655 |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2019-04-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 1934P | KY | Nursing Service Providers |
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
3001937 | KY | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3532 Ephraim Mcdowell Dr, Louisville, KY 402053224 | 5024566200 | 5024566655 |
| Street Address |
3015 WILSON AVE |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40211-1969 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275534091 | Lisa G Glass | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2005-08-02 |
| 1083215362 | Yazmine Jaquez | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-11-04 |
| 1982211405 | Domini Williams | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-09-29 |
| 1497361091 | Treana Redd | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-09-18 |
| 1356954366 | Janneve Sankawulo | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-08-28 |
| 1588274260 | Robyn May | Dentist | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-08-06 |
| 1124638184 | Symone Stephens | Registered Nurse | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-08-05 |
| 1275151292 | Park Duvalle Community Health Center, Inc | Clinic/Center | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2020-07-07 |
| 1598312415 | Elissa Grider | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211-1969 | 2019-08-26 |
| 1730733783 | Mark A Bush | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211 | 2019-07-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942792940 | Kare LLC | Dentist | 2500 W Broadway Ste 500, Louisville, KY 40211 | 2018-06-05 |
| 1265943716 | Practicare Home Care Services, LLC | Nurse Practitioner | 1667 Russell Lee Dr, Louisville, KY 40211 | 2017-10-23 |
| 1518478221 | Latoya Samantha Hall | Counselor | 646 South 36th Street, Louisville, KY 40211 | 2017-10-20 |
| 1003071200 | Mark Cassol Md Psc | Ophthalmology | 2600 W. Broadway, Suite 105, Louisville, KY 40211 | 2008-07-28 |
| 1194919548 | Hardin Housing Corp | Assisted Living Facility | 2035 S 41st St, Louisville, KY 40211 | 2007-08-29 |
| 1184770562 | Eta Day Care Center LLC | Case Management | 724 So 44th Street, Louisville, KY 40211 | 2007-01-26 |
| 1871571356 | Alice C Gunnison | Physician Assistant | 2406 West Broadway, Jencare Neighborhood Medical Center West Broadway, LLC, Louisville, KY 40211 | 2006-01-05 |
| 1730694266 | Orchid House, Inc. | Early Intervention Provider Agency | 703 S 31st St, Louisville, KY 40211 | 2017-12-06 |
| 1891188785 | Mary Jo Pitts | Registered Nurse | 2406 West Broadway, Jencare Neighborhood Medical Center West Broadway, LLC, Louisville, KY 40211 | 2015-03-17 |
| 1164717492 | Priscilla Nana Ama Owusu | Internal Medicine | 2406 W Broadway, Louisville, KY 40211 | 2011-06-15 |
| Find all providers in zip 40211 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326695255 | Norton Childrens Medical Group, LLC | Nurse Practitioner | 1930 Bishop Ln Ste 101710th, Louisville, KY 40218-1921 | 2019-08-26 |
| 1407402209 | Elleanor Gray | Nurse Practitioner | 411 E Chestnut St Ste 645, Louisville, KY 40202-1713 | 2019-08-16 |
| 1245287440 | Tammy A Pasko | Nurse Practitioner | 234 E. Gray St., Ste. 270, Louisville, KY 40202-1903 | 2006-05-31 |
| 1013988351 | Kellie Woodruff | Nurse Practitioner | 411 E Chestnut St # Street7, Louisville, KY 40202-1713 | 2006-01-26 |
| 1639172554 | Sharon C Metcalf | Nurse Practitioner | 555 S Floyd St, Louisville, KY 40202-3801 | 2005-05-24 |
| 1619582616 | Erica Ashley Persichetti | Nurse Practitioner | 90 Health Park Dr Ste 160, Louisville, CO 80027-9742 | 2020-09-15 |
| 1295361723 | Karen A Powers | Nurse Practitioner | 411 E Chestnut St # Street7, Louisville, KY 40202-1713 | 2020-03-16 |
| 1346872074 | Elizabeth Cotton | Nurse Practitioner | 231 E Chestnut St, Louisville, KY 40202-1821 | 2020-02-11 |
| 1336771161 | Norton Children's Medical Group, LLC | Nurse Practitioner | 1930 Bishop Ln Ste 101710th, Louisville, KY 40218-1921 | 2020-02-10 |
| 1689206906 | Lacey G Sanford | Nurse Practitioner | 417 Benjamin Ln Ste 101, Louisville, KY 40222-4939 | 2020-02-05 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40211 |
Please comment or provide details below to improve the information on KELLY A JEDLICKI.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.