Provider Demographics
NPI:1548131469
Name:TILLETT, KEELIE (APRN)
Entity type:Individual
Prefix:
First Name:KEELIE
Middle Name:
Last Name:TILLETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5069 TEALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-6355
Mailing Address - Country:US
Mailing Address - Phone:502-220-2661
Mailing Address - Fax:
Practice Address - Street 1:151 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:EMINENCE
Practice Address - State:KY
Practice Address - Zip Code:40019-1149
Practice Address - Country:US
Practice Address - Phone:502-845-6288
Practice Address - Fax:502-845-1000
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4044338363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty