Provider Demographics
NPI:1902491202
Name:KILLEN, RACHEL C (APRN-FNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:C
Last Name:KILLEN
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1263 SPRINGDALE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1736
Mailing Address - Country:US
Mailing Address - Phone:859-625-8664
Mailing Address - Fax:
Practice Address - Street 1:1263 SPRINGDALE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1736
Practice Address - Country:US
Practice Address - Phone:859-625-8664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily