Provider Demographics
NPI:1447035290
Name:MARTIN, KAYLYN MACKENZIE (APRN)
Entity type:Individual
Prefix:
First Name:KAYLYN
Middle Name:MACKENZIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KAYLYN
Other - Middle Name:MACKENZIE
Other - Last Name:POPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-896-4246
Mailing Address - Fax:
Practice Address - Street 1:3920 DUTCHMANS LN STE 315
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4702
Practice Address - Country:US
Practice Address - Phone:502-896-4246
Practice Address - Fax:502-896-1136
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4008834363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily