Provider Demographics
NPI:1699101352
Name:BROWN NEWTON, KILEY YAGER (MSN, APRN, NP-C)
Entity type:Individual
Prefix:
First Name:KILEY
Middle Name:YAGER
Last Name:BROWN NEWTON
Suffix:
Gender:F
Credentials:MSN, APRN, NP-C
Other - Prefix:
Other - First Name:KILEY
Other - Middle Name:YAGER
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:444 SO 1ST STREET #100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1416
Mailing Address - Country:US
Mailing Address - Phone:502-583-6647
Mailing Address - Fax:502-585-4824
Practice Address - Street 1:1700 OLD BLUEGRASS AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1162
Practice Address - Country:US
Practice Address - Phone:502-361-3909
Practice Address - Fax:502-361-9229
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008291363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK093661Medicare PIN