Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 3011686 | KY |
N | 363LG0600X | Nurse Practitioner - Gerontology | 3011686 | KY |
NPI | 1093224594 |
---|---|
Provider Name | Kelly Ryan Bohl |
First Address | Lexington, KY 40536-0001 |
Second Address | Lexington, KY 40536-3787 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2017 |
Last Update Date | 14/01/2020 |