Provider Demographics
NPI:1114157948
Name:CREMEANS, KELLI S (APRN)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:S
Last Name:CREMEANS
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4156 STARRUSH PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-9077
Mailing Address - Country:US
Mailing Address - Phone:859-242-7836
Mailing Address - Fax:859-955-5024
Practice Address - Street 1:4156 STARRUSH PL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-9077
Practice Address - Country:US
Practice Address - Phone:859-242-7836
Practice Address - Fax:859-955-5024
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0101476-C-NP363LF0000X
VA0024188893363LF0000X
KY3006123363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100085230Medicaid
KY0952509Medicare PIN