Provider Demographics
NPI:1487385589
Name:HUMLONG, KELLEIGH CREASON (APRN)
Entity type:Individual
Prefix:
First Name:KELLEIGH
Middle Name:CREASON
Last Name:HUMLONG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KELLEIGH
Other - Middle Name:CREASON
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:4452 BANYAN PARK
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-9055
Mailing Address - Country:US
Mailing Address - Phone:270-210-4324
Mailing Address - Fax:
Practice Address - Street 1:1740 NICHOLASVILLE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1431
Practice Address - Country:US
Practice Address - Phone:859-260-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014973363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care