KIOSK MEDICINE KENTUCKY LLC
NPI 1205885035
Nurse Practitioner - Family in Louisville, KY

Q: What is Kiosk Medicine Kentucky LLC's NPI number?

The NPI number for Kiosk Medicine Kentucky LLC is 1205885035. It was assigned to this organization in the NPPES registry on May 9, 2006.

Q: What is Kiosk Medicine Kentucky LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Active since May 09, 2006CLIA 18D1015023 · Waiver

3039 BRECKENRIDGE LN, LOUISVILLE, KY 40220(502) 451-4555(502) 451-0884 Get Directions Write a Review

NPPES record last updated: October 21, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: May 12, 2025, Dec 12, 2024, Jun 21, 2019 and 2 more (5 updates tracked since 2016).

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About Kiosk Medicine Kentucky Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KIOSK MEDICINE KENTUCKY LLC (NPI 1205885035) is a healthcare organization registered as a family in Louisville, Kentucky and active in the NPI registry since May 2006. The organization holds a CLIA Waiver certificate valid through July 21, 2027 and lists Thomas Shelly, Vp & General Manager, as its authorized official.

NPPES Registry Identity

NPI1205885035

Entity TypeOrganization

Primary Taxonomy363LF0000X

Legal Business NameKIOSK MEDICINE KENTUCKY LLC

Location Address3039 BRECKENRIDGE LNLouisville, KY 40220-2101

Mailing AddressPo Box 932958Cleveland, OH 44193-0028 · (615) 425-4200 · Fax (615) 425-4201

Phone(502) 451-4555

Fax(502) 451-0884

Organization SubpartNo

Authorized OfficialThomas ShellyVp & General Manager · (615) 425-4200

Enumeration DateMay 9, 2006

Last NPPES UpdateOctober 21, 20255 updates tracked since enumeration

NPPES CertifiedOctober 21, 2025

✔ NPI 1205885035 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

Also ListedPhysician AssistantTaxonomy 363A00000X

3039 BRECKENRIDGE LN, Louisville, KY 40220

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Other Identifiers 1

Medicaid7100276100KY

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Home State Health, Ambetter Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 18D1015023

Kiosk Medicine Kentucky, LLC · Louisville, KY

Active · expires Jul 21, 2027

CLIA Number18D1015023

Laboratory TypeOther

Certificate Effective DateJuly 22, 2025

Certificate Expiration DateJuly 21, 2027

Laboratory DirectorMs. Erin Macy

Laboratory Phone(502) 451-4555

Laboratory LocationKiosk Medicine Kentucky, LLC3039 Breckenridge Lane, Louisville, KY 40220

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

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Other Providers at the Same Location NPPES 19

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MICHELLE WADDLES CRIMES

Nurse Practitioner (Family)