KIOSK MEDICINE KENTUCKY LLC
NPI 1679996631
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 1679996631. It was assigned to this organization in the NPPES registry on January 28, 2014.

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 January 28, 2014CLIA 18D2001883 · Waiver

12450 LA GRANGE RD, LOUISVILLE, KY 40245(502) 638-4783(502) 638-4784 Get Directions Write a Review

NPPES record last updated: October 21, 2025. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: May 12, 2025, Dec 12, 2024, Dec 20, 2016 (3 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 1679996631) is a healthcare organization registered as a family in Louisville, Kentucky and active in the NPI registry since January 2014. The organization holds a CLIA Waiver certificate valid through January 3, 2028 and lists Thomas Shelly, Vp & General Manager, as its authorized official.

NPPES Registry Identity

NPI1679996631

Entity TypeOrganization

Primary Taxonomy363LF0000X

Legal Business NameKIOSK MEDICINE KENTUCKY LLC

Location Address12450 LA GRANGE RDLouisville, KY 40245-1901

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

Phone(502) 638-4783

Fax(502) 638-4784

Organization SubpartNo

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

Enumeration DateJanuary 28, 2014

Last NPPES UpdateOctober 21, 20253 updates tracked since enumeration

NPPES CertifiedOctober 21, 2025

✔ NPI 1679996631 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

12450 LA GRANGE RD, Louisville, KY 40245

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Other Identifiers 1

Medicaid7100274230KY

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 18D2001883

Kiosk Medicine Kentucky LLC · Louisville, KY

Active · expires Jan 3, 2028

CLIA Number18D2001883

Laboratory TypeWalk In Healthcare Clinic

Certificate Effective DateJanuary 4, 2026

Certificate Expiration DateJanuary 3, 2028

Laboratory DirectorErin Macy

Laboratory Phone(502) 855-3264

Laboratory LocationKiosk Medicine Kentucky LLC12450 La Grange Road, Louisville, KY 40245

CLIA data matches this NPI record on: Address Name

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

Other Providers at the Same Location NPPES 13

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

KROGER LIMITED PARTNERSHIP I

Pharmacy (Community/Retail Pharmacy)